A lot of awareness has been raised about the detrimental effects of taking too much sugar but did you know that salt can be just as harmful to health as sugar? A high salt consumption can raise blood pressure and increase one’s risk for heart disease, stroke and kidney failure.

The Malaysian Community Salt Survey (MyCoSS) has found[1] that Malaysians consume an average of 7.9g of salt per day. This amount is far higher than the World Health Organisation’s (WHO) recommendation[2] of less than 5g a day of salt or just under a teaspoon.

Why Malaysian Food is high in Salt Content

A big part of why Malaysians consume a lot of salt is because Asian food, especially Malaysian food, is high in salt content. We use a lot of sauces and seasoning to flavour all our favourite staples. There is scarcely a Malaysian dish that does not use kicap masin, kicap pekat, kicap lemak, oyster sauce, fish sauce, belacan, stock cubes and the various ready-made perencah that we liberally pour into our cooking. And then we add additional salt to further bring out the flavour in the dish as we cook. Added to that would be the obligatory side dip of soy sauce and cili padi or sambal belacan or various other condiments and sauces that we serve to accompany the main dishes. Otherwise the meal wouldn’t have the “kick” that Malaysian food is so famous for.

Added to that is the fact that we additionally eat many salt-preserved foods such as ikan bilis, salted eggs and salted fish as part of our daily diet.

Over at the stalls and coffeeshops which we patronise very often, the meals that are sold are also high in salt. In fact, according to this study[3] , Malaysian street food contains the highest amount of salt out of which 30% are deepfried. So, there’s the combination of high fat and high salt.

The study says that the highest amount of salt is found in the snack category. A few examples would be fish-based snacks such as Keropok Lekor. Others include fried fish balls, fried crab meatballs, fried chicken with cheese, fried sotong and fried sausages and meat balls.

The highest salt content has been found in street food snacks (433mg) followed by main meals (335mg) and then, desserts (168mg). Fried noodles and noodle soup as main meals contain the highest amount of salt (more than 2000mg) per serving as they are cooked using a variety of sauces.

And then there are the processed snacks sold in grocery stores such as packaged crisps and crackers which contain 500 to 815mg of salt.

Salt Reduction Campaign

To counter our high salt consumption to reduce the burden of Non-Communicable Diseases (NCDs) in Malaysia such as high blood pressure and heart disease, Malaysia embarked on a salt reduction campaign[4] in 2015. The first Salt Reduction Strategy which was from 2015 – 2020 did not achieve its target although there was a slight reduction in salt intake. It is now followed by the second Salt Reduction Strategy from 2021 – 2025. The goal is to work towards achieving a 30% reduction of salt intake by 2025.

Salt is Not All Bad

Salt, which is also known as Sodium Chloride, and sometimes just referred to as sodium, is known to cause NCDs. However, the body cannot do away with all salt as it is an essential mineral needed to perform a range of physiological functions. For example, salt is needed to regulate electrolytes and fluids in the blood, transmit nerve impulses, contract and relax muscle fibres and maintain a healthy blood pressure and volume.

The Danger of Eating too much Salt

Eating too much salt, however, is bad for the body. Too much salt predisposes individuals to high blood pressure which increases the risk of stroke, heart disease and chronic kidney disease.

According to the 2019 National Health and Morbidity Survey, 30% of adults aged 18 years old and above have high blood pressure[4].

Eating too much salt raises one’s chances of getting an enlarged heart, headaches, heart failure, high blood pressure, kidney disease, kidney stones, osteoporosis, stomach cancer and stroke[5].

How does a High Salt Diet affect Children?

Children are not immune to all of these effects. There is now evidence to show that a high salt intake in children affects the child in the same way as adults; predisposing him or her to develop chronic health problems such as high blood pressure, obesity, heart disease, osteoporosis, respiratory illnesses such as asthma, and stomach cancer.

• Osteoporosis

Although Osteoporosisis is more often associated with older people, studies[6] have shown that losing calcium through the urine due to eating a high salt diet has been detected in children too. Leaching calcium into the urine can lead to osteoporosis, bone fragility and breakage especially in girls who are more susceptible than boys.

• Obesity

Eating a high salt diet causes thirst. After eating a bag of potato chips, a child might reach for a can of soda or soft drink to quench his thirst. While salt does not directly cause obesity, sugary drinks do. It has been found that 31% of four to 18-year-olds drink sugary soft drinks[7] which is related to childhood obesity.

How Much Salt Should Children have?

Children’s eating habits start from young. If they are given salt from the moment they start eating adult food, they will develop a liking for the taste. This taste preference will influence their eating patterns into adulthood. It will be difficult to reduce their sodium intake after the habit has been formed.

Children who have just begun weaning should not have any salt or seasoning added to their food.

The daily recommended sodium intake for children[8], according to actiononsalt.org is:

• Ages one to three – maximum intake of 2g a day
• Ages four to six – maximum intake of 3g a day
• Ages seven to 10 − maximum intake of 5g a day
• Ages 11 and above − maximum intake of 6g a day

*To measure grams by teaspoon, one level teaspoon is equal to 6 to 7g of salt[9].

This total recommended intake includes hidden salt found in packaged or canned foods, deli meats such as cold cuts and sausages, as well as ready-made burgers and patties, and all kinds of fish and meat cakes and balls.

How to Reduce your Children’s salt Intake

Given the above guidelines on salt intake for children, here are some ways to reduce children’s salt intake:

• Give them healthy snacks of fruit and vegetables instead of highly-salted junk food.
• Limit buying street snacks and meals. Limit consumption of fast food and stall food.
• Cook more at home as you can control the salt that goes into the meals.
• Omit the use of salt in homecooked meals. There is no need to add additional salt in food that has already been flavoured with seasoning.
• Lessen the amount of seasoning. Most of our seasoning sauces and soy sauces are already heavily laced with salt. You can flavour the food using herbs, spices and vegetables.
• Reduce your own salt intake gradually and your tastebuds will adjust accordingly. After a few weeks of salt reduction, you will not miss the taste of salt so much. Translate this practice into your homecooked meals for the family.
• Monitor your child’s and your family’s intake of salt by watching how they eat their favourite foods and snacks.

Signs that your Child may be Consuming too Much Salt

Apart from getting high blood pressure, here are a few other symptoms that your child may exhibit due to eating too much salt.

• Frequent Thirst

Thirst doesn’t necessarily mean your child is eating too much salt but consuming too much salt does make one thirsty. If your child is frequently very thirsty for no apparent reason, check to see if it is because he has been eating too much salty food.

• Disturbed Sleep

Eating too much salt especially just before bed, can lead to sleep disturbances such as restless sleep, waking up often at night and not feeling rested in the morning.

• Stomach Discomfort

Too much salt can irritate your child’s digestive tract or stomach which can lead to nausea, vomiting, abdominal cramps or diarrhoea.

• Dark, Yellow Urine

Too much salt consumption can cause dark, yellow urine with a strong smell. The dark colour shows that the urine has become concentrated with less water secreted.

• Weight Gain

While salt in itself may not a be a direct cause of weight gain except for water weight, a high salt diet is nevertheless linked to higher body fat. There are two reasons for this:

1. Eating a lot of salt causes the body to retain more water, causing the body to bloat and put on water weight.
2. The foods that are high in salt are snacks, fast food, fried foods, street foods, processed food and restaurant or stall food. Eating too much of these foods will cause one to put on weight.

• Bloated Appearance with Swollen Hands and Feet

Eating too much salt causes the body to retain extra sodium and draw water from the cells[5] to increase fluid in the body. This may result in swelling, bloating and puffiness[5] especially in the hands and feet.

If your child has eaten too much salt, make him or her drink lots of plain water to flush out the excess salt and normalise sodium levels. Potassium is an effective mineral that helps relax blood vessels and increase sodium excretion while decreasing blood pressure. Feed your child bananas as the fruit is high in potassium. Other potassium-rich foods include leafy greens, dairy foods like yoghurt and starchy vegetables like pumpkins and other squashes.

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[1]Institute for Public Health (IPH) 2019. Population-Based Salt Intake Survey To Support The National Salt Reduction Programme For Malaysia (Malaysian Community Salt Survey – MyCoSS)
[2]World Health Organization: WHO. (2023, September 14). Sodium reduction. https://www.who.int/news-room/fact-sheets/detail/salt-reduction

[3]Haron, H., Arifen, Z. N. Z., Shahar, S., Mohamad, H., Yazid, S. F. Z. M., Michael, V., Abeyasinghe, R., Taketo, T., & Trieu, K. (2022). Street food in Malaysia: What are the sodium levels? Foods, 11(23), 3791. https://doi.org/10.3390/foods11233791
[4]Non-Communicable Disease (NCD) Section, Disease Control Division, Ministry of Health Malaysia. 2021. Salt Reduction Strategy to Prevent and Control NCD for Malaysia 2021-2025

[5]Telltale signs you’re eating too much salt. (n.d.). WebMD. https://www.webmd.com/diet/ss/slideshow-too-much-salt

[6]Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism. (2000, June 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/10928292/

[7]Ludwig, D. S., Peterson, K. E., & Gortmaker, S. L. (2001). Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. The Lancet, 357(9255), 505–508. https://doi.org/10.1016/s0140-6736(00)04041-1

[8]Salt and children - Action on Salt. (n.d.). https://www.actiononsalt.org.uk/salthealth/children
[9]Aksel, O. (2023, February 2). Grams to teaspoons: conversion table for sugar, flour, salt and more ingredients. Cotswold Flour. https://cotswoldflour.com/blogs/baking-resources/grams-to-teaspoons