My column last week (“Canned goods, instant noodles are killing us softly,” 08/10/19) apparently stirred up a hornet’s nest. I received varied reactions.

Some kindly cautioned me to be careful about pushing my “theories on salt sensitivity” on Filipinos and Asians, and how it should be managed with the right medicines.

Definitely, it’s no longer a theory or unproven hypothesis. One only needs to scan the literature for robust evidence showing that Asians—and most likely Filipinos—are generally more salt-sensitive compared to Caucasians. This is aggravated by our fondness for salty foods, snacks and other processed products.

Someone commented: “Konting manas lang ang side effect ng maaalat na pagkain, iiihi rin lang natin yan! (Eating salty foods only lead to slight edema and we can easily get rid of that through the urine.)”

This is the reason I might sound like I’m on panic mode. I’ve been seeing that lackadaisical attitude toward increased salt intake in the population for as long as I can remember. Meanwhile, the apathy has been killing hundreds of thousands over the years. It’s one of our mass murderers, yet many look the other way and consider it a benign sinful pleasure.

200,000 deaths yearly

We can still enjoy eating without compromising our health and life. Salt, in excess, should not be part of it. Too much salt retained in the body may lead not only to high blood pressure, but cardiovascular disease (CVD) in general, heart failure, stroke and premature death.

CVD and stroke have remained the top two killers in the country for the last 30 years. They account for a third of all deaths annually—around 200,000 Filipinos dying yearly.

Increased salt intake is particularly related to the risk of developing stroke. Last year, Dr. Joey Navarro, a highly respected neurologist practicing at the University of Santo Tomas Hospital, said in a symposium that there are too many stroke patients, and a relatively small number of neurologists or brain specialists to take care of them.

Navarro pointed out that the neurologist-to-patient ratio in the Philippines is 1:330,000 Filipinos. The big irony is that most of the brain specialists are practicing in the big cities, so many Filipinos who suffer a stroke can’t even be attended to by a brain specialist.

Filipinos and Asians have three times higher risk of developing a stroke than having a heart attack—the opposite of what we see in Caucasians. I believe the higher salt sensitivity of Asians has something to do with it.

I wager my reputation as a physician on what I’ve been saying in my discourses—that if we could cut our population’s salt intake by half in five years’ time, we can reduce our incidence of new strokes by at least 50 percent. Our best bet is for companies to reduce salt in processed foods. Gentle persuasion won’t work anymore. We need legislation to compel food manufacturers to comply with safe limits for salt in processing food products.

Making cooked food taste bland, without any salt, makes only a small dent on total salt intake, so I don’t recommend it especially for the elderly. If they don’t eat enough anymore because of the bland foods they’re given, they’ll get into more serious nutrient and electrolyte problems. It must still be palatable to taste, but refraining from using additional salty condiments like bagoong, toyo or patis would help.

Body needs salt

I must emphasize, though, that people need some salt in their body, around 5 grams per day. Too low sodium in the blood, called hyponatremia, can also lead to serious brain complications in the elderly. A regular diet should be able to provide this, but steer away from processed foods and salty condiments.

Another problem associated with higher salt sensitivity and higher salt intake is heart failure, especially in diabetics. Beware if you’re diabetic. Again, this is no longer a hypothesis.

There have been several reports in the last three years showing that Asian diabetics have a higher risk of developing heart failure compared to their American and European counterparts. More than half of heart failure cases reported in Asia are due to diabetes.

The higher salt sensitivity among Asian diabetics is likely the reason the diabetic population in the region, compared to Caucasians, respond better in some subanalyses to the new antidiabetes class of drugs called SGLT2 (sodium glucose co-transporter-2), inhibitors in terms of cardiovascular benefits.

It’s not because they can bring down the blood sugar more effectively (in fact, they’re among the weakest sugar-lowering drugs), but they prevent heart failure hospitalization and cardiovascular deaths remarkably as a class of drugs, most likely due to their salt-eliminating, or diuretic effect.

So, diabetics at risk of heart failure should be given SGLT2 inhibitors if they could afford it—around P60 per tablet without senior’s discount. If they could not, I recommend the use of tried-and-tested antidiabetic agents like metformin and gliclazide, plus a low-dose long-acting diuretic like indapamide or chlorthalidone.

I recommend the low-dose diuretic, even if the diabetic is not hypertensive. This regimen should cost less than P20 per day, and could potentially save them much more in hospitalization cost for stroke and heart failure. It could even perhaps save some diabetics from dying prematurely due to CVD.