South African Legislation Cuts Sodium from Food

Canned soup, fast food, frozen meals, - oh my! What do these all have in common? Too much sodium, that’s what. Too much sodium can exacerbate high blood pressure, which is associated with cardiovascular disease. This in turn may result in 20 million deaths globally each year. And if that’s not bad enough, stoke is one of the leading causes of disability.

Recently, South African became one of the first countries in the world as well as in Africa to pass sodium content regulations. This was to encourage their population to reduce salt and sodium consumption.

Salt is made up of sodium and chloride and is not the same as sodium. Salt contains 40% sodium, which increases blood pressure and the risk for heart disease and stroke.

Research at Wits University and Harvard, titled Sodium reduction legislation and urinary sodium and blood pressure in South Africa, was published in JAMA Cardiology in February 2025. It showed that this legislation has worked and may continue to reduce blood pressure in the future.

The World Health Organization recommends we consumed under two grams of salt per day; subjects in this study cut their sodium intake by 10% over seven years. 

“In addition, many more people achieved the ideal sodium consumption: the number went from 7% to 17% and with every gram of sodium reduction, there was a reduction in blood pressure,” says Professor Steve Tollman, Director of the SAMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt – where the study was done). 

South Africa’s sodium legislation is the most extensive of any country

This legislation resulted in thirteen food categories reducing their sodium content. These included bread, cereals, butter and margarine spreads, chips, processed meats, soups, sauces, and bouillons.

Food manufacturers had to reduce their sodium content in their foods between 20% to 70% by 2016, then cut them further by 5% to 46% by 2019.

Drops in blood pressure

“If this reduced sodium consumption remains constant over time, it could be associated with lower rates of cardiovascular disease mortality as well as of stroke, heart failure, end-stage renal disease, and vascular dementia, all of which are also associated with high blood pressure,” says Associate Professor Thomas Gaziano of the Harvard T.H Chan School of Public Health. Gaziano is also the lead and corresponding author of the study.

He adds that reductions of just one millimeter of mercury (mmHg) of blood pressure can result in tens of thousands of deaths averted each year.

Tollman notes, “This kind of research insight suggests other countries can adopt similar laws and potentially see reductions in death and disability, including the US.” 

Potential reversal of high blood pressure levels associated with older populations

South Africa has a higher population of aging adults and “transitioning” societies. During a transition, infectious diseases are replaced with chronic conditions such as cancer, diabetes, heart disease, and obesity as leading causes of death. As countries develop economically and move from rural to urban settlements, this change occurs. Lifestyle modifications and where the rural/urban divide is not as well defined.

This study was done in an aging cohort, as part of the Health and Aging in Africa: Longitudinal Studies in South Africa (HAALSA) program, a partnership between Wits, Harvard, University of Cape Town, and the Columbia University Department of Neurology. 

HAALSA measures how policy and other social determinants of health impact chronic and infectious diseases, including dementia, cardiometabolic disorders, and HIV, in South Africans aged 40 and over to better understand health outcomes within a growing older population.

To evaluate the impact of sodium regulation, the study assessed the salt intake and blood pressure among the HAALSA cohort, which included over 5,000 adults aged 40 and above, in rural SA. 

The researchers measured sodium levels in participants’ urine and took their blood pressure at three different times: in 2014, before the regulations were implemented, and again in 2018 and 2021.

“Most governments around the world have only encouraged or advised sodium reduction with limited effectiveness. Stricter legislation is better than a voluntary approach," says Tollman. "This study demonstrates that government action with accountability is able to impact not only on sodium intake but blood pressure levels as well.”

Here are tips to cut sodium from your diet:

·         Read labels for sodium content. Look for items with 140 mg or less sodium per serving (5% of the Daily Value).

·         Limit fast food and read the nutrition facts when you order it.

·         Avoid the use of frozen meals and snacks.

·         Buy low-sodium versions of sauces, soups, and condiments.

·         Try herbs and spices to season food in place of salt and bottled sauces.

·         Choose canned or frozen vegetables packed without salt.

·         Taste your food before salting it.

·         Limit ultra-processed breakfast and lunch meat.

·         Make your own soup and avoid canned soups and stews.

·         Use unsalted or lightly salted nuts for snacks in place of chips or pretzels.

Lisa Andrews, MEd, RD, LD

Reference:

Gaziano T, Kapaon D, du Toit JD, et al. Sodium Reduction Legislation and Urinary Sodium and Blood Pressure in South Africa. JAMA Cardiol. Published online February 05, 2025. doi:10.1001/jamacardio.2024.5410