In March 2013, South Africa was hailed internationally for the introduction of ground breaking legislation to make salt reduction in the food industry mandatory. What many people don’t know was that the initiative started out as a small research project in the Chronic Disease of Lifestyle Unit of the Medical Research Council, says Dr Krisela Steyn.

Dr Steyn, tells the story of how she and Professor Naomi (Dinky) Levitt supervised a PhD student, Dr Karin Charlton, with her study of salt sensitivity in black communities.

Studies had shown that South Africans were consuming about 7.8g to 9.5g and some as much as 40g of salt per day, significantly increasing their risk of developing hypertension.

The aim of Dr Charlton’s study was to take the usual foods that black populations ate at their level of available resources, turn them into healthier products by reducing the salt content and increasing the potassium content, and then determine whether that would lower hypertension.

“The student worked closely with the food industry, getting players to reduce the salt content in bread, replace some salty shakes with potassium and also decrease the percentage of salt in about seven or eight products consumed on a regular basis,” Dr Steyn continues. “It was a difficult randomised control trial involving both low salt and normal products over an eight-week period in the township of Langa. It was possible to prove after that period that people who consumed the lower salt products had significantly lower blood pressure.”

The results were seen to be seminal and she submitted the data to the National Department of Health (NDOH) for consideration. The Department subsequently identified salt reduction as one of their important projects. The Heart and Stroke Foundation worked with many stakeholders to start ‘Salt Watch’, a multidisciplinary group who undertook to educate the public and create awareness of the risk posed by excessive salt consumption. “In South Africa, only 60% of salt intake is provided by products prepared by the food industry, the other 40% is from discretionary use during cooking or adding salt at the table, so people had to be sensitised also to reduce their personal use of salt,” says Dr Steyn.

Presented with the findings, health minister, Dr Aaron Motsoaledi was convinced, and by 2012 legislation had been drafted to ensure that the food industry would reduce salt content in a number of specified products.

Dr Steyn concludes, projections showed that proposed salt cuts would lead to a 10% drop – or 7 000 fewer deaths from heart attacks – and 4 000 fewer non-fatal strokes each year. “We’re cooperating with Australian colleagues on the path forward and working with the Potchefstroom School of Nutrition in developing plans for measuring the impact, but we are confident that by 2020, salt consumption will be reduced.”