This April 1st, 2021, the Tico Ministry of Health gave a little encouraging data. The adult population of Costa Rica consumes an average of 11.3 grams of salt per day, the equivalent of almost two teaspoons. That is, more than double the value recommended by the World Health Organization (WHO), which is five grams per day or, rather, one teaspoon.
The result? A population more prone to high blood pressure and, with it, other related problems. Among them are heart disease and cerebrovascular infarcts; We already have one of the highest mortality rates in the region.
The most recent data from the Institute of Statistics and Censuses (INEC) indicates that, of the total deaths reported in 2019 (24,237), 6,144 people died from diseases related to the circulatory system. This represents 25% of deaths, well above tumors with 5,468 cases.
First, it is necessary to clarify that salt is not the same as sodium. Salt is a mineral that contains sodium, and the latter is the one that causes problems when consuming more than recommended. If we go to the part of the diet, there is scientific evidence that shows a strong relationship between the sodium we consume and blood pressure.
“A person with high blood pressure has an additional risk factor for various cardiovascular diseases. Therefore, the best recommendation here is to reduce salt in order to lower sodium levels”, commented Dr. Guiselle Zúñiga Flores, professor at the School of Nutrition of the University of Costa Rica (ENU-UCR) and coordinator of the Section of Normal and Clinical Nutrition in the same academic unit.
For Dr. Zúñiga, controlling sodium intake reduces pressure by up to 10%, making it a fairly effective and economical measure. Even the World Health Organization (WHO) itself estimates that 2.5 million deaths in the world would be avoided if salt intake were reduced to the recommended level.
But, in all this, there is still a question that worries. If the benefits of consuming salt in a moderate way are so evident for health, why is it taking Costa Ricans so much to achieve adequate consumption?
Masked problem
Behind the excessive consumption of salt hides an even more complex reality permeated in Costa Rican society: unfavorable changes in eating patterns increasingly oriented towards fast and processed foods.
According to Verónica Vargas Monge, an advanced undergraduate student at the ENU-UCR and who with two other colleagues develop her thesis on salt consumption, the current excess in sodium consumption is due to multifactorial phenomena.
These phenomena range from the cultural and food tradition part (such as eating a mango or pineapple with salt when it is not necessary) to the high availability of food offered by the food industry and the large number of food services. Among them, sodas and restaurants.
The problem is excess
“The problem is excess. Currently we have more food availability, also the possibility of having meals outside the home or resorting to already prepared or packaged food. Canned foods usually have a significant amount of sodium as a preservative and this is sometimes not considered in the calculation of daily intake. As a result, we consume a significant amount without even knowing it,” Vargas said.
To this is added a more hurried daily life and people with greater obligations of work, family and studies. From Vargas’s perspective, this change in daily chores has exacerbated the preference for foods prepared to facilitate eating. Yes, quick to quench hunger, but sometimes not nutritionally adequate enough.
“Food is not prepared as before and the industry has taken advantage of this change to develop ready-made products that we have been adopting. Many of the determining factors when shopping is not how much sodium a certain food has, but how much it serves me and how easy it is for me to use it,” the undergraduate student added.
But in all this there is another great masked consumption and it is in packaged sauces, consommés and condiments. When making homemade preparations, these ingredients are usually added and additionally the main source of sodium in Costa Rica, according to the Ministry of Health: domestic salt.
That aggregate tends to do without considering the amount of sodium that those sauces or packaging already bring. At the end of the day, the person ingested all that consumption without realizing it and exceeded the recommended amount in a completely inadvertent way.
Family habits
“Costa Ricans find it difficult to control their salt intake, mainly due to a taste acquired in our palate that begins from childhood. If my mom or dad cooked with a certain amount of salt, when I become independent I will continue repeating that pattern because I have already accustomed my palate to that level of salt. This makes us, many times, not be aware of how much salt we add.
“Another important aspect is that people do not usually measure salt when they cook at home and when referring to a pinch of salt, it is not always really a pinch but a larger quantity”, reflected Dr. Karolina Sánchez Alán, specialist in sensory evaluation of the food from ENU-UCR and graduate of Kansas State University.
In addition, Dr. Sánchez explained: “we must have a moderate sodium intake. Sodium is an essential micronutrient for the body that plays a fundamental role in various physiological processes in the human body. The problem is excess. Its excessive consumption is associated with adverse health effects such as high blood pressure. So, the key is to be aware of the amount of salt we consume, of the foods that provide us with a greater amount of sodium, such as sausages, and try to check the labels when we buy our food”.
Facilitate consumption monitoring
The key to achieving adequate sodium intake is to facilitate monitoring and remove those little big temptations. One of them? The salt shaker on the table. Also, in measuring the amount of salt that we are adding to the meals and in using natural spices to season the meals without losing the flavor. The ones that you could get the most out of are thyme, paprika, basil, oregano, pepper, to name a few of the best known.
“With salt something very interesting happens, and that is that the salty taste is not determined only by the level of sodium in the food. There is an interaction between sodium and other components that will influence this perception. If I use garlic, sweet chili, celery, thyme, oregano, and other natural scents, it is not necessary to add more salt, these mixes can exacerbate the salty taste without requiring adding more sodium. One of the most effective mixtures to add flavor to the preparations is when combining carrot, celery, onion and garlic, to cite an example”, emphasized Dr. Sánchez.
For its part, the Ministry of Health recommends the use of sweet chili and lemon to flavor foods. In addition, it advises to reduce the use of sauces such as the English type, soy, tomato and dressings; limit the consumption of packaged snacks; drain and rinse canned vegetables; as well as eating fresh fruits and vegetables without adding salt to them. Also, you should know other alternative names for a food that contains sodium. For example: sodium chloride, sodium benzoate, or monosodium glutamate.
Let’s go back to our roots
Right now the world is experiencing a food change. Román González Arce, anthropologist and nutritionist at the UCR, said that the large food industries have homogenized the diet and, from that point of view, traditional food (varied and rich in nutrients) is a local privilege that must be preserved.
Just look at the following data: in Costa Rica there are more than 46 indigenous foods that have been relegated from the diet of Costa Ricans. Some of them are even more nutritious than spinach. This was explained by Dr. González in a news item released on World Food Day.
These are wild foods collected, most are not cultivated, but are born naturally in the patios, on the side of the roads and even between the crops. Underutilized vegetables can be edible leaves, stems, tips, flowers, shoots, hearts of palm, mushrooms, fruits, beans and roots.
Do you want clearer examples?
Take a look at the purslane, the chicasquil, the flower of the poró, the chayote quelites, the jaboncillo or calalú, the quelites, the flowers and the seeds of squash, the chiverre, fungi, coyol, the leaves, the root and base from the trunk of the wild papaya.
These foods are very nutritious, but some stand out for their high nutritional value, such as girls, whose content of protein, calcium, iron, Vitamins A and C are far superior to other foods of foreign origin such as spinach.
“Many foods have been disparagingly labeled as ‘poor food’, thus discouraging their consumption. At the same time, imported foods have gained ground in the taste of consumers, also displacing the cultivation of national landraces”, concluded Dr. González.
In Children
The pediatric population has seen an increase in non-communicable chronic diseases such as obesity, diabetes and hypertension. The latter, due to the excess in the consumption of foods high in sodium and which is an underdiagnosed pathology in children. In Chile, a prevalence of around 2 to 3% was found. (Source: Scientific article: Hypertension and salt intake in pediatrics).
Contribution to change!
The students Verónica Vargas Monge, Angie Calvo Castro and Kimberly Campos Carvajal, under the supervision of Dr. Ana Beatriz Avendaño, Dr. Anne Chinnock Elizabeth and Dr. Karolina Sánchez Alán, are doing a final graduation work to determine the amount of acceptable sodium in common Costa Rican preparations.
To achieve this, they need volunteers willing to go to the UCR School of Nutrition, try different dishes and answer a series of questions. With the results it is desired to propose an accepted level of sodium in a realistic way to the Costa Rican context.
If you want to participate, please register at the following link: https://forms.gle/p353G1fp6bq6PqU2A Remember, you must live within the Greater Metropolitan Area, not suffer from hypertension or any cardiovascular disease, and appear on the day of the test, which will be promptly communicated by the research team.
