Public presentation (June 2013)

1. Public presentation (June 2013) Reducing salt in the diet to protect health: Easy and effective Associate Professor Nick Wilson Department of Public Health University of Otago, Wellington, New Zealand nick.wilson@otago.ac.nz uow.otago.ac.nz/BODE3-info.html

2. Contents Why salt is an important health problem? What can be done – at a personal level? What can be done by government – and is it a good use of government funds?

3. Salt vs sodium Salt is sodium chloride (NaCl) Sodium is an element which occurs naturally and is used by the body 1g of sodium = 2.5g of salt (1 teaspoon = 6g)

4. Salt: Historically important Once critical for food preservation – but we now have fridges, freezers and canning Image: Carlos Porto / freedigitalimages.net

5. Too much salt in the diet Raises blood pressure  increased risk of heart attacks and stroke Possibly around a third of heart disease could be prevented if the salt risk factor was eliminated

6. Not just heart attacks & strokes: Stomach Cancer Osteoporosis Kidney Disease Charity Registration No. 1098818

7. Too much salt in the diet Major study “Global Burden of Disease 2010” ranked the risk factor “diet too high in salt” as 11th most important risk factor for health loss globally In NZ – also ranked 11th (ahead of diet low in fibre, diet low in vegetables, diet high in red meat)

8. How much for adults? • NZ/Australia recommendations: <2300 mg day sodium (just under 6 g of salt) • That’s just one teaspoon’s worth! • But 80% or more is hidden in processed foods (not added at the table or cooking)

9. Top sources in NZ Nutrition survey data • Bread • Processed meats • Sauces 9

10. Personal action • Beware of excuses: “but my blood pressure is okay” – as salt makes BP rise with age • Focus on reducing the big 3: bread, processed meat, sauces • Minimise in cooking (phasing down & you may not notice) 10

11. Simple swaps Swap: Ham or cheese sandwich For: Egg or tuna sandwich Plain popcorn Crisps Dried Fruit Biscuits

13. Eat more fruit & vegetables – the potassium reduces the risk of stroke 13

14. Societal level action • Successful campaigns in the UK, Japan & especially Finland • NZ – some progress by bread manufacturers (with Heart Foundation) but salt levels still fairly high 14

15. Societal level action needed • Upper limits on salt in bread, processed meats, sauces • Better labelling – is coming • Could consider junk food taxes (help with obesity as well)? 15

16. Improved food labels Simpler, easier to understand eg,:

17. Good use of government resources? • Yes – 13 international studies all indicate this (esp. laws on upper limits); 8 studies: costs saved. • Health system savings – fewer heart attacks and strokes • Consumer acceptability – don’t notice a 10%/year reduction 17

18. Rationale for government role • Society expects safe food (government bans bacterial contamination of food) • The taxpayer-funded health system pays for the heart attacks and strokes • Economic cost to society when workers die of heart attacks 18

19. Conclusions • Excess dietary salt – an important problem (rank=11th) • Easy options for personal action • Government action makes sense eg, upper limits & better labelling • This would improve health & probably save health dollars 19

20. Acknowledgements • Thanks to Heather Kizito, Stroke Foundation • Some online materials from “Consensus • Action on Salt & Health” (UK) Email: nick.wilson@otago.ac.nz 20