The Puritans are back. In the past, they condemned gluttony, but now they blame all the abundent good tasting food for obesity, which is now epidemic all over the world.

Yup. Blame the fast food places and those multinational corporations, and those who run efficient ways to make food cheap and abundant, from hybrid crops to fertilizer to chicken farms.

Actually, I’m old enough to remember the good old days, when starvation was common, and we were told to eat everything on our plate and not waste food, because children were starving in China.

Nowadays, obesity is a growing problem in China too. And yes, as a doc I worry about the health problems of obesity, but since dying at age 65 of diabetes is better than dying of starvation at age 4, I figure it is worth it.

One of the public health problem here in Asia is high blood pressure.

Why?

Blame they soy sauce, the Fish sauce (AKA Patis) and other high salt condiments that enable us to enjoy the “ulam” (soup/side dishes) that we eat with our rice.

One of the results is that high blood pressure and strokes are common here, even among our poor. We see young folks dying with strokes, something we used to see 40 years ago, but that is now rare in the US, where new medicines enable us to lower blood pressure.

Here in the Philippines, the government is working to provide cheap generic drugs for treatment.  Yet even generic Amlodipine costs 11 pesos (22 cents) for a five mg pill. If you are a farmer or tricycle driver or factory worker in the provinces, you might only make 3oo pesos a day, and have to feed your family of six on that salary. So lots of folks, especially in times when money is tight (e.g. before the next harvest) will stop taking their pills.

So is it the salt?

Well, when I worked in poor rural Africa, the diet was very low in salt; The only high blood pressure we saw was in the educated, who ate “European” food; yet when I worked in another area, closer to the ocean, where salt was abundant, we saw lots of high blood pressure.

So studies suggesting a low salt diet will prevent the development of hypertension are probably true.

However, I have to roll my eyes up at the latests Nanny state initiative: from the Washington Post:

Two members of Congress urged the Food and Drug Administration on Tuesday to move quickly to limit the amount of salt in processed foods, calling the matter a “public health crisis” that demanded a swift response from government.

Public health problem, yes. Crisis? No.

And how bad is this “crisis”?

“Clearly, salt is essential; it is a good thing; we need it,” said Jane Henney of the University of Cincinnati… “But the levels we’re taking in right now are far beyond the maximum levels we need. We should be taking in about a teaspoon a day, but we’re consuming about a teaspoon and a half, and it’s creating tremendous risk in terms of development of hypertension and numerous diseases.”

If I remember correctly, Americans eat 6 to 10 g a day; we need two to five gms a day.

When we didn’t have medicines to treat fluid retention or high blood pressure, we used to put people on a 1 gm sodium diet.  However, once the diseases were there, the diet didn’t help much. You have to start the lower salt diet at an earlier age, to prevent the high blood pressure from starting.

Asians however consume 10 to 15 gms a day, and in the past it was higher.

Which is probably why death from hypertension is so common in East Asia.

Blame the Soy sauce, the Patis/Fish sauce and other condiments that were used to flavor the rice.  I wonder if the decrease in salt consumption in the Japanese is due to the fact they now have other foods, so don’t need to use salt to make their food palatable.

So anyway, I have no problem with using education and public pressure to lower the salt content of food. However, the end result could be to switch to higher fat items in the menu, or add high fat condiments to substitute the lost flavor of salt.

I have a big problem with the government forcing the manufacturers and fast food joints. Change from above doesn’t work when it comes to food:

Did you ever hear of a salt shaker?

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Nancy Reyes is a retired physician living in the rural Philippines. She blogs at HeyDoc Xanga blog

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