Finally, after having written about it numerous times since 2014, we get the good news that the government is seriously considering to propose legislation to impose “sin taxes” on excessively salty foods on the market.

Contrary to what many think, the greatest amount of salt we ingest does not come from salty condiments. The biggest source is processed foods, which include canned goods, salty snacks, frozen meals, instant noodles, margarine, ketchup, even dried fruits.

Practically all processed food products are high in sodium due to the addition of salt as a preservative.

I have emphasized this in a scientific paper which was recently accepted for publication in the European Journal of Cardiovascular Medicine (“Increased Salt Sensitivity and Dietary Salt—Killing Asians ‘Softly’”; manuscript accepted for publication Oct. 25, 2019).

In the paper, I wrote: “Excise taxes, otherwise known as ‘sin taxes’ for unhealthy products like cigarettes and liquor, should also be imposed on food products which have exceeded allowable limits of sodium content. Processed products like ‘instant meal’ preparations are being patronized for their relatively low cost and convenience to prepare. If their cost is increased due to the ‘sin taxes,’ consumers may have to give it a second thought before buying, and ponder a bit on the health consequences.”

As harmful as cigarettes

Can excessively salty foods be that “sinful”?

The data suggest that they could be just as harmful as cigarettes, and probably more harmful than alcohol. As I’ve written previously, “They’re killing us slowly (and softly), and we don’t even realize it.”

Medical organizations and health advocates have been trying to convince snack food makers to reduce their products’ salt content up to 50 percent, but sadly, the plea seemed to have fallen on deaf ears.

Legislation could require all food manufacturers, restaurants and food outlets to put prominently on the label or on the menu the amount of sodium and other substances in the food products they manufacture or serve. This will enable the consumer to make an intelligent choice whether or not to buy their products.

The World Health Organization recommends that adults consume less than 2,000 mg of sodium or 5 g of salt per day. The average Filipino diet is around 12-15 g per day.

Some soups we’re fond of, for example contain more than 1,000 mg of sodium per cup. Pizza can have 400 mg to 1,200 mg per slice.

Unwittingly, many of us also indulge in other rich sources of sodium such as anchovies, bacon, cheese, gravy granules, ham, olives, pickles, prawns, salami, salted and dry roasted nuts, salted fish, smoked meat and fish, soy sauce, stock cubes and yeast extract.

Lesson from Japan

Japan taught us a very convincing lesson on the benefits of reducing salt intake.

In the 1950s, the incidence of strokes in Japan reached alarming levels, prompting the government to take urgent action. The salt intake of the Japanese was very high then, likely due to processed foods.

Through a concerted multisectoral program which included a lot of public education, the Japanese reduced their salt intake by half. This reduced the average blood pressure of the population by 18 mm Hg, and the rate of stroke was reduced by 80 percent.

The average life span in Japan also increased significantly.

If we can do the same in the Philippines, this could translate to more than 50,000 lives being saved annually.

We should consider the problem of salt sensitivity when we treat hypertensive and diabetic patients. Ignoring this is treating them inadequately.

Diuretics

We’ve explained before that the best pill that can address the increased salt intake and salt sensitivity in Filipinos and Asians is still the so-called “water pill” or diuretics that can help eliminate excess salt in the body. But using standard doses of diuretics can make one, especially the elderly, lose electrolytes and feel weak.

What I recommend is low-dose diuretic combined with other drugs. By low dose, I mean just a quarter, at most, half of the standard recommended doses.

The government can make local drug manufacturers customize such a single-pill combination for Filipinos. I’m sure this will still be much cheaper, yet more effective, than the common antihypertensive medicines the government is giving out.

I relayed in this column my experience, when a doctor in the province told a patient of mine that the drug (a diuretic) I prescribed was antiquated. True, diuretics are among the oldest drugs in cardiovascular medicine, introduced in the ’50s. But they remain the most effective, so far, to eliminate excess salt from the body.

Unfortunately, our local doctors—even the cardiologists—shun the use of diuretics.

If we look at the data objectively, many doctors are wrong in thinking that diuretics are inferior to the so-called modern drugs used to treat hypertension and other heart diseases.

Addressing our salt problem with appropriate legislation and use of the most suitable drug—a diuretic-based regimen—could help save scores of thousands of Filipinos annually.