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The perils of overconsumption

While the state is considering implementing high-sodium tax, consumers should be more vigilant, especially for hidden salt

Three years ago, the World Health Organization (WHO) adjusted its daily recommendation of sodium intake and suggested adults not consume more than 2,300mg per day. But an average Thai takes 4,350mg of sodium on a daily basis -- almost twice the WHO's healthy threshold.

Despite ongoing campaigns and activities both from public and private sectors, the overconsumption of sodium and salt among Thais is still a worrying national healthcare concern.

"We are speaking of non-communicable diseases or NCDs here," said dietitian Pakthima Chaopradit. "Consuming too much sodium in the long run could potentially lead to chronic diseases. It could lead to the country's economic loss, premature deaths, worsening work performances and disabilities. Eventually it could be a burden not just on a person and family but on a national scale."

In an attempt to cut people's health problems as a result of excessive sodium intake, the Excise Department plans to tax ingredients that are sources of salt. While the details as to how much tax will be levied on high-sodium foods are being worked out, the Excise Department said the protocol is expected to seek cabinet approval by the end of this year.

Unlike the excise tax on sweet beverages that was implemented last year where manufacturers are given a two-year incentive period to reduce sugar amounts, the sodium tax is said to provide a five-year relief period for local manufacturers to reduce salt from food production. The tax policy will reward manufacturers who manage to cut levels of salt within the time frame. Also according to the Excise Department, ready-to-eat frozen foods will not be taxed given the fairness principle wherein the same dishes freshly cooked by vendors are exempt. Also preserved foods such as salted fish and salted eggs would not be included in the tax protocol.

The high-sodium levy is designed to curb the level of salt in foods because medical practitioners all agree that the overconsumption of it leads to high blood pressure, a silent killer that is responsible for 7.5 million deaths worldwide, or about 12.8% of all deaths annually, according to figures from the WHO. Across the globe, almost a billion people were reported suffering from high blood pressure, two-thirds of whom were in developing countries. It is also predicted that the number of people with high blood pressure would rise to 1.56 billion by 2025.

Thailand is now seeing a constant rise in the number of people with hypertension too. Last year the country was reported to have 5.5 million people suffering high blood pressure, up from 3.9 million in 2013, according to data from the Strategy and Planning Division under the Ministry of Public Health. New cases are also alarmingly on the rise -- from around 540,000 new hypertension patients in 2015 to 813,000 last year.

All this has changing lifestyles at its root, especially the lack of physical activity and excessive salt intake, among other unhealthy habits.

"High blood pressure is likely to lead to other more complicated chronic diseases including kidney disease, coronary artery diseases and stroke," added Pakthima.

What's more disturbing, according to the nutritionist, is the fact that sodium can be found in foods that don't look salty. Instant noodles or seasoning like fish sauce are obviously high in sodium. An instant noodle pack contains 1,480 to 1,500mg while a tablespoon of fish sauce has 1,620mg of sodium. But, surprisingly, things like juices or even supposedly healthy stuff like whole-wheat bread contain sodium too.

"A glass of tomato juice, for example, contains 280mg of sodium. A tablespoon of ketchup has 149mg of sodium while a slice of whole-wheat bread has 125mg of sodium. A number of industrialised foods have sodium as a preservative. So consumers have to be careful of their choices," said Pakthima.

The body can rid itself of excessive sodium through urination and sweating but for those with inadequate water intake, that could lead to water retention as sodium is well absorbed by cells and brings water in with it. Too much salt means too much sodium in the bloodstream, reducing the ability of the kidneys to remove water. The result is higher blood pressure due to the extra fluid and extra strain on the delicate blood vessels leading to the kidneys. If left unattended, kidneys can be damaged, resulting in kidney diseases.

In Thailand, the 2016 statistics revealed that around 8 million Thais suffer from chronic kidney disease, the third highest among Asean nations after Malaysia and Singapore. Over 70% of kidney diseases are a result of diabetes and high blood pressure.

Personally, Pakthima took aim at seasoning provided at restaurants and food vendors.

"When a noodle dish is served, for example, most of us add spoons of fish sauce. Many do so as a habit without realising the salty liquid is actually harmful to health. Personally I think the habit of adding seasoning when dining out is more worrying than eating frozen foods," she said.

While the high-sodium tax is a state measure to cope with the national health conundrum, what's more crucial is how to educate consumers, especially the young ones, about how excessive sodium intake is detrimental to health so that they cut it at a young age.

"Schools should play a part too," she suggested. "Snacks should not be allowed to be sold in schools. Children must be taught about the danger of too much salt so that they grow up to become adults who are not addicted to such foods.

"Awareness should be raised among consumers too. Seasoning should be cut and crispy snacks should be replaced by fruits. Consumers should pay more attention to product labels. Read them more carefully before every purchase and keep an eye on any sodium components that appear on the labels." And for long-term solutions, food manufacturers should be educated too.

"Tax is just a part of the story," Pakthima said. "Think cigarettes. Tax is increased for cigarettes too. Cigarette pack warnings are compulsory. But people still smoke. This means raising awareness should be more effective."

A pack of instant noodles contains 1,480-1,500mg of sodium. Photo: Patipat Janthong

  • One tbsp of soy sauce: 1,190mg
  • One tbsp of oyster sauce: 518mg
  • One tbsp of sweet chilli fried chicken sauce: 385mg
  • One tbsp of chilli sauce: 231mg
  • One tbsp of ketchup: 149mg
  • Omelette over rice dish: 362mg
  • Fresh spring roll dish: 562mg
  • Khao moo krob (deep-fried pork belly over rice): 700mg
  • Stir-fried morning glory over rice: 894mg
  • Som tam: 1,006mg
  • Pad see ew (Thai stir-fried noodle dish): 1,352mg
  • Egg noodle soup with roasted pork: 1,480mg
  • Thai-style sukiyaki in broth: 1,560mg
  • Yen ta Fo noodle soup: 1,417m

Information from the Institute of Nutrition, Mahidol University

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