SINGAPORE — In an effort to eat healthily, people may try to make better food choices when they dine out or at home, choosing to eat a bowl of noodle soup instead of fried food at the hawker centre, or have a salad or a “cleaner” lunch.
Yet, even when they choose one of these seemingly healthier food options, they might be exceeding the daily limit of sodium intake.
High sodium intake is among the pressing public health concerns in Singapore, with nine in 10 people here consuming almost double the recommended daily limit by the World Health Organization, which is 2,000mg of sodium — equivalent to 5g or slightly less than a teaspoon of salt.
Salt is made up of 40 per cent sodium and 60 per cent chloride.
Findings from the National Nutrition Survey 2022 here showed that the daily sodium intake of Singapore residents rose from 3,480mg in 2019 to 3,620mg last year.
Along with this was a drastic increase in the proportion of people with hypertension, or high blood pressure.
In 2021 and 2022, more than a third of Singaporeans (37 per cent) were found to have hypertension. The figure was nearly double of the 19.8 per cent in 2010.
The chronic disease — which increases the risk of life-threatening illnesses such as kidney failure, stroke and heart attacks — does not affect only older adults.
Professor Tan Huay Cheem, senior consultant at the National University Heart Centre, Singapore, pointed out that around one in 12 (8.1 per cent) of young people between 18 and 29 years old have hypertension, based on the recent National Population Health Survey.
Prof Tan, who is chairman of the Singapore Heart Foundation, added: “For this young population, the risk of developing cardiovascular complications in future is significant.”
He recently spoke at the Symposium on Sodium Reduction in Singapore and the Role of Salt Substitutes, which took place at the Lifelong Learning Institute on Oct 21.
Organised by the Singapore Heart Foundation, the Singapore Nutrition and Dietetics Association, and National Kidney Foundation, the event featured talks and discussions on reducing sodium intake and the prevalence of heart and kidney-related illnesses in the population here.
WHERE ARE THE HIDDEN SALT IN FOOD?
Senior dietitian Natalie Yeo from the Singapore Heart Foundation said that a major source of sodium comes from salt and sauces added during food preparation and cooking, as well as in meals sold at eating places.
“Some foods such as bread, breakfast cereals and processed meats are fairly rich in sodium, too. And all of these can add up,” she said.
Some foods are obviously high in salt (such as fries, bacon, tinned and preserved food), but you will also need to look out for the less obvious choices that may be loaded with sodium. For example:
A bowl of fish ball noodle soup contains at least 2,900mg of sodium, which exceeds more than 100 per cent of the daily recommended sodium limitA bowl of lor mee (noodles with starchy gravy) contains about 2,500mg of sodium, most of which is found in the thick gravyA bowl of mee soto (yellow noodles with shredded chicken in spicy soup) has 2,600mg to 3,700mgA piece of masala thosai (crispy crepe with spiced potato and onion filling) contains around 780mg of sodiumThousand Island dressing (commonly used in salads) contains 863mg of sodium per 100g. Add grated parmesan cheese (about 1,500mg per 100g) and croutons (about 700mg per 100g), and a serving of salad will easily exceed the daily recommended sodium limitEven the healthier versions of bread such as wholemeal bread, focaccia and French baguette are relatively high in sodium, with each 100g serving containing around 500mgSteamed dim sum: Three pieces of steamed prawn dumplings contain 222mg of sodium, and two rolls of chee cheong fun (steamed rice rolls) with sweet sauce will add on another 400mg
The sodium content for each dish or food item may vary, depending on how it is prepared.
WHAT ABOUT SODIUM IN DRINKS?
Sports drinks are promoted to help replenish electrolytes, fluids and glucose lost during a strenuous workout, improve endurance and energy levels.
Steer clear of these drinks if you are watching your sodium intake and not exercising vigorously or for extended periods of time.
Sports drinks contain electrolytes such as sodium and potassium.
Depending on the brand, the sodium content for every 100ml of the drink can range from 46mg to 92mg. For example, a 325ml can of 100 Plus contains around 150mg of sodium.
Such drinks are designed for use during exercise sessions that last more than 90 minutes, Ms Yeo said.
“They are more suited to support athletes during their training by fuelling energy to the muscles and brain,” she added.
“It is not a good idea to turn to electrolyte drinks as a go-to beverage because it is possible to over-indulge.
“If the individual is not doing a vigorous workout, it could add to his or her overall calorie and sugar intake, too.”
WHY ARE PEOPLE TAKING MORE SALT?
Ms Yeo said that the increase in salt intake and hypertension numbers reflects evolving lifestyles and dietary habits among Singaporeans.
“For example, individuals with busy and hectic lifestyles tend to eat out more than cook.
“Without being mindful, sodium intake could quickly add up while dining out regularly,” she said.
“Also, there is an increasing availability of processed foods on the go, as well as a wide variety of choices available through food delivery services.”
Our tastebuds play a role, too. If you have always been eating food high in salt content, that can dull the sensitivity of your tastebuds.
“This results in a need for a higher concentration of salt for one to detect saltiness,” Ms Yeo added.
WHAT HAPPENS WHEN YOU TAKE TOO MUCH SALT?
While sodium is an essential nutrient for the body, it needs only around 500mg — or less than a quarter teaspoon — each day to function normally, Prof Tan said.
The nutrient helps transmit nerve impulses, contract and relax muscle fibres including those in the heart and blood vessels, and maintain a proper fluid balance.
However, too much sodium is harmful to body.
After having a salty meal, a person may experience symptoms such as feeling bloated, feet swelling, thirst and frequent urination.
“Natural excretion of excess salt will be carried out by the body.
“(The symptoms) are usually self-limiting and resolve with time, with little consequences as the body able to regulate the sodium level through natural excretion,” Prof Tan explained.
“However, too many holiday parties, rich salty hors d’oeuvres, delectable cakes and pudding can harm your cardiovascular health. This can increase risk of high blood pressure and stroke,” he added.
“High level of sodium in the blood stream reduces the kidneys’ ability to remove water.
“This can cause the body to retain water, resulting in an increase in overall blood volume, which then increases stress on the blood vessels, causing hypertension.”
Prof Tan said that it is important to reduce sodium intake from an early age. From age 18, people should also monitor their blood pressure even though hypertension is less common in younger people.
HOW TO WEAN OFF SODIUM
Ms Yeo said that slowly reducing sodium from your diet and adjusting to less salty flavours can help people get accustomed to a lower-sodium diet.
This can be done in 21 days or three weeks.
She suggested doing this gradually over three weeks, starting with being more mindful of food choices when dining out, buying takeaways or ordering in:
Opt for plain rice instead of flavoured riceAsk for no or less salt, sauces and gravyConsume less gravy or soups. Refrain from finishing the soup when you have a soup dish because this is where a lot of sodium isAdd aromatics, fresh herbs and spices if you need more flavour in your mealIf you still prefer having sauces or dressing, ask that they be served separately. Only dip when necessary and do so sparinglyRefrain from dipping into extra condiments such as soy sauce and chilli sauceConsider lower-sodium alternatives such as potassium salt (K-salt), which contains 30 per cent less sodium.However, people with medical conditions such as chronic or advanced stages of kidney disease should exercise caution with this salt substitute unless under guidance by a health professional. When kidney function is poor, the organs may not be able to excrete excess potassium from the body effectively, Ms Yeo said.
WHAT TO KNOW ABOUT LOWER-SODIUM SALT SUBSTITUTES
Ms Yeo said one thing to note is that Himalayan salt, sea salt, rock salt and kosher salt are not table-salt substitutes since they have similar sodium content by weight.
In a joint statement, the Singapore Nutrition and Dietetics Association, Singapore Heart Foundation and National Kidney Foundation emphasised the urgent need to reduce sodium intake in the population here to prevent diseases.
One of the key strategies it highlighted at the symposium last month was the use of lower-sodium salt substitutes, such as potassium-enriched salt and other salt blends with monosodium-glutamate or yeast extract.
Lower-sodium salt substitutes use a variety of minerals and ingredients to lower the sodium content of the product while preserving taste.
“These substitutes can be used as one-for-one replacements for regular salt,” Prof Tan said.
USING MSG TO REPLACE TABLE SALT
Derived from glutamate, flavour enhancer MSG is a naturally occurring amino acid that is found in nearly all foods.
MSG can be used as a substitute for salt or used to replace some sodium chloride in table salt. It contains less than a third of sodium in table salt.
This is among the strategies to reduce sodium intake, by the Singapore Nutrition and Dietetics Association, Singapore Heart Foundation, and National Kidney Foundation.
In a joint statement issued by these three parties at a symposium last month on sodium and salt substitutes, they also highlighted that:
The glutamate in MSG is chemically indistinguishable from naturally occurring glutamates in foods, such as tomatoes and cheeses, as the body metabolises both sources of glutamate in the same wayThe consensus among regulatory agencies worldwide is that MSG is safe for consumption when used in accordance with good manufacturing practices. These agencies include the United States Food and Drug Administration, European Food Safety Authority, Food Standards Australia New Zealand and the Joint FAO/WHO Expert Committee on Food Additives, which is an international scientific expert committee that is administered jointly by the Food and Agriculture Organization of the United Nations and the World Health OrganizationWhile there have been claims of adverse reactions to MSG, such as headaches, perspiration and feelings of numbness, these claims have not been substantiated by scientific evidenceSome people may be sensitive to MSG, just like any other food ingredient, but these cases are rare, and the symptoms are mild and short-lived
Senior dietitian Natalie Yeo from the Singapore Heart Foundation said it is important to note that MSG can still affect one’s health if it increases the person’s sodium intake.
In a 2022 study cited in the National Library of Medicine, a biomedical library in Maryland of the United States, the recommended dose for daily consumption of MSG is less than 6g a day for adults
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