Watch that salt! It just might be killing you

• It is one of the cheapest and most popular items on the shopping list yet it is also one of the most dangerous, with its high intake being linked to increased risk of heart and blood vessel diseases more than any other lifestyle factor

The disease patterns in Africa are slowly and steadily shifting from infectious, communicable diseases to non-communicable illnesses more common in high-income nations. Life expectancy in the continent is also rising and our already challenged health systems are feeling the strain as adult diseases become more widespread.

Cardiovascular diseases — which are conditions that affect the heart and blood vessels — are on a steady rise in low and middle income countries.

Dr Anthony Etyang, a consultant physician at the Kilifi District Hospital as well as a clinical scientist at the KEMRI-Wellcome Trust Collaborative programme, is a worried man. Over the years, Dr Etyang has collated published data on causes of admissions and deaths in adults in sub-Saharan Africa, and his findings paint a gruesome picture of the future of Kenya’ health.

In a paper published in the Global Health Action Journal in January this year, Dr Etyang and colleagues reported a definite rise in cardiovascular diseases from less than four cases per 100 admissions in the 1950s to over 20 cases per 100 admissions by 2010.

But, since in their review most of the data came from urban areas, the researchers sought to know what the situation was like in other rural parts of Africa. To achieve the objective, they decided to compile the causes of death from the adult ward at the Kilifi District Hospital for the period betweeb 2007 and 2011.

Again, the findings were heartbreaking; out of the 15,528 admissions, 1,041 were due to heart and blood vessel diseases, which in this case was stroke and heart failure. Despite the fact that heart and blood vessel diseases made up slightly less than seven per cent of all admissions, it was the cause of a sizeable portion of deaths, second only to infectious and parasitic HIV-related diseases.

Out of the 1,543 deaths during the five year period, 224 were due to heart and blood vessel diseases. One out of every five adults admitted at Kilifi District Hospital for cardiovascular diseases died as a result of the illness.

This brings to attention the fact that heart and blood vessel diseases are not necessary ailments afflicting urban populations only.

The main risk factor for heart and blood vessel diseases is untreated high blood pressure or hypertension. But what makes one most at risk of hypertension?

After the age of 55, the risk of developing hypertension is high. According to the World Health Organisation, one out of every three adults worldwide has hypertension. Unfortunately, other than die young, there is not much one can do to avert old age. Nonetheless, there are risk factors that can be somewhat controlled.

The most commonly talked about risk factors, the so called ‘lifestyle changes’, include alcohol, smoking, stress, obesity and lack of exercise. And it is a fact that too much time sitting at the office or in front of the television, coupled with eating fatty, starchy or sugary foods, does increase the risk of these illnesses.

Yet Kilifi is one of the poorest districts in the country. You rarely encounter obesity in both the rural and urban areas. Fast-food shops are rare and red meat is a luxury. The staple foods include maize meal, beans, cassava and green vegetables. And, although Kilifi has huge numbers of boda boda and tuk-tuks, a lot of people still walk to work.

The upshot is simple: there is a far cheaper, deadlier cause of heart and blood vessel diseases in Kenya. The culprit is salt, one of the cheapest items on any shop shelf, with a 500mg packet going for Sh12.

Its effects are global in scale. A Lancet Journal review of 2012, authored by two Egyptian Professors (Mohsin Ibrahim and Albertino Damascero), reported that scientists had found stronger evidence linking high salt intake to heart and blood vessel disease than any other lifestyle risk factor.

This review discussed research conducted in America that found that African-Americans were more susceptible to high blood pressure than Caucasians due to salt sensitivity.

American scientists are not in agreement about race being a contributor to salt sensitivity despite some evidence that there is a gene among African-Americans that causes them to retain the sodium in salt, whereas Caucasians tend to excrete more of it.

In high-income countries, most of the salt is found in processed and mass produced food. In places like Kilifi, the majority of the people cannot afford processed foods and most of the salt that finds its way into the body is added during cooking or after serving.

“If you walk around Kilifi, you will not find obese, lazy, non-exercising people, and although we do not have the data yet, I am convinced that salt plays a major role in the high incidence of cardiovascular diseases here,” says Dr Etyang.