(This sheet is summary of links to the above website as of July 2004)

Salt and Hypertension (High Blood Pressure)

What is 'salt'?

The chemical name for salt is'sodium chloride'. Salt provides our bodies with the minerals 'sodium' and 'chloride', which are both needed for us to function normally.

Which foods contain salt?

Salt is found in almost every food we eat, but the amount present in different foods varies a great deal. Most of the salt we eat (about 75%) comes from processed foods. High salt processed foods include soy sauce, processed meats, canned soups, canned anchovies, and stock cubes. About 15% of the salt we eat comes from the salt we add at the table or in cooking.

Most fresh foods (vegetables, fruit, nuts and unprocessed meats) are naturally low in salt and contribute little to the salt we eat.

How much salt do I need?

We do need to eat some salt. The amount of salt in our food is measured in millimoles (mmol) or milligrams (mg) of sodium. The current recommendation is that we eat no more than 100mmol (or 2300mg) of sodium per day. You can easily get your requirements from the natural salt in fresh foods, so there is no need to add salt to a healthy eating plan.

What's wrong with eating too much salt?

Most of us eat more salt than we need. Eating too much salt can lead to high blood pressure (also called hypertension). High blood pressure increases your risk of heart disease and stroke. If you already have high blood pressure, eating too much salt may make it worse.

High blood pressure affects almost a third of people who are over 50 years of age. Almost one half of Australians have high blood pressure before they reach the age of 70.

Enjoying a healthy eating pattern that is low in salt is one way to help control your blood pressure, or avoid high blood pressure altogether. The effect salt has on blood pressure varies from person to person. Elderly persons are usually more sensitive to changes in salt intake.

How can I eat less salt?

• Avoid high salt foods
• Avoid processed foods such as processed meats, commercial sauces, soups, packet seasoning and stock cubes (other than those that are labelled'no added salt''low salt', or salt reduced).
• Avoid potato chips/crisps, high salt take away foods and salted nuts.
• Enjoy plenty of fresh vegetables and fruit.
• Choose foods normally processed without salt and foods labelled'no added salt','low salt' or'salt reduced'.
• Choose low salt breads and cereals.
• Choose packaged foods with a sodium content of no more than 120 milligrams per 100 grams (note: some'salt reduced' foods don't meet these recommendations).

Low salt and low sodium foods are defined as foods with a sodium content of no more than 120mg/100g (or 120mg/100ml for liquid foods). Look at the “Nutrition Information” panel on the package and read the sodium content in the “per 100g” or “per 100ml” column.

If the sodium content is given in grams instead of milligrams per 100g, convert to milligrams by multiplying by 1000 (e.g. 1.2g/100g = 1200mg/100g).

Salt reduced foods
It is ideal for people with hypertension to choose'no added salt' and'low salt' foods. If these are not available the 'reduced salt' version of the food, although not ideal, is still a better choice than the regular product.

However, foods that are labelled 'salt reduced' are not necessarily low salt foods. It is a good idea to read the nutrition information panel to check the actual amount of salt in the 'reduced salt' product.

For a food to be called 'salt reduced', its sodium content must be reduced from that of the standard product by at least 90mg/100g and must not exceed a total of 600mg/100g. In other words, it is possible for a salt reduced food to contain as much as five times more salt than the maximum allowed for a low salt food (120mg/100g).

Avoid adding salt at the table

• To flavour food use freshly ground pepper, fresh or dried herbs, vinegar or balsamic vinegar, lemon juice, fresh mustard (made from powdered mustard), and fresh garlic or garlic powder.
• Buy commercial no-added-salt sauces.
• Try making your own sauces, pickles and chutneys without adding salt.
• Vegetable salt, rock salt, sea salt, garlic salt and celery salt are no different to ordinary salt and should be avoided.
• Potassium chloride is another product often used as a salt alternative. You should check with your doctor before using it.

Avoid using salt in cooking

This includes cooking salt, onion salt, celery salt, garlic salt, MSG, beef and chicken stock cubes, stock powder, soup cubes, gravy powder and soy sauce. Instead, use:

• acidic (tart) flavours such as vinegars, and fruit juices such as lemon, lime, plum, tamarind and pineapple juice;
• curry spices such as cumin, cardamon, cinnamon, ginger, turmeric, chilli, clove, coriander, pepper and mustard;
• other flavours such as fresh herbs, garlic, onion, chives, spring onion, horseradish, table wine, sherry;
• 'no added salt', 'low salt', or 'reduced salt' varieties of stock powders and stock cubes (available in most supermarkets).

How long does it take to get used to a low salt eating pattern?

It will take time to adjust to a low salt eating pattern, but be patient! Although food may at first taste bland, after a month or so it will taste quite acceptable. If you're having trouble, try reducing your salt intake gradually, in a stepwise fashion, until your taste buds get used to the other flavours in foods.

Some people may no longer need medication for their blood pressure, or may require less medication, if they eat less salt, if they make changes to their eating habits like eating more vegetables and fruit, and if they become more physically active.

Is there ever a problem with reducing salt intake?

People with kidney disease, or those taking certain medications (such as lithium or diuretics) should check with their doctor before changing the amount of salt they eat. Women who are pregnant should also talk to their doctor before making any changes.

Do we ever need to take extra salt?

After heavy sweating, for example in hot weather or when exercising, you may need to drink more water but you won't need more salt. Your body automatically adjusts by making sweat less salty and passing less salt into the urine. It is very unlikely you will ever need extra salt unless advised by your doctor.

What else can I do to help lower blood pressure?

To help lower blood pressure, apart from limiting salt intake, it is important to:

• Achieve and maintain a healthy weight - Reducing excess weight can lower blood pressure in most people. Being overweight, particularly excess weight carried in the abdominal area, are risk factors for coronary heart disease and diabetes. Being physically active, limiting alcohol intake and healthy eating (see below) can assist with weight loss.
• Be physically active - The Heart Foundation recommends that people include 30 minutes or more of moderate intensity physical activity (such as brisk walking) on most, if not all days of the week, for health benefits. The amount of activity can be accumulated in shorter bouts, such as three 10-minute walks.
• Limit alcohol intake - If you drink alcohol, limit yourself to one or two drinks per day.

How can I further reduce my risk of heart disease and stroke?

Apart from high blood pressure, other risk factors for heart disease and stroke include cigarette smoking, a high blood cholesterol and diabetes. To help lower your risk:

• Be smokefree - For information on quitting smoking call Quitline 131 848;
• Enjoy healthy eating to help lower blood cholesterol levels by choosing mainly plant-based foods such as bread, cereals, rice, pasta, vegetables, fruits and legumes (dried peas, beans and lentils), and moderate amounts of lean meats, poultry, eggs, fish, reduced-fat dairy products and polyunsaturated and monounsaturated margarine and oils.

For more information contact the Heart Foundation's telephone information service Heartline on 1300 36 27 87 (cost of local call).

April 2001