Battling stroke by fighting salt: the Portuguese strategy

June 23, 2009 by  

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saltPortugal has one of the highest mortality rates due to stroke in Western Europe and this has been attributed to the high salt intake of the population. Many Portuguese traditional food – including the salted fish delicacy bacalhau (salted cod) – contains high amounts of sodium chloride. However, even the normal daily fare such as bread also contains a lot of salt. The result is that the Portuguese population, take in, on the average, twice the amount of the recommended daily salt intake. -the stroke rate there is twice that of coronary disease.

A group of health led by Dr. Luis Martin of the Fernando Pessoa University formed the Portuguese Action Against Salt and Hypertension (PAASH) and conducted studies on Portuguese salt consumption habits and the health consequences. The results show that:

  • An adult consumes on average 11.9 g of sodium per day, two times the recommended daily intake.
  • Portuguese bread contains an average of 19.2 g of sodium per kg, which is 53% more than what is found in bread in other European countries. This highly contributes (21%) to the daily sodium intake.
  • The amount of salt by consumed by the population correlated with blood pressure and aortic stiffness.
  • In 2007, only 29% of the Portuguese population was aware of the health risks of excessive salt consumption

The PAASH advocates saw an immediate need for action to increase awareness and reduce salt consumption. They estimated that “a reduction of just 1 g per day of salt intake would save almost 2500 lives per year in Portugal, which has a population of around 10 million.”

Dr. Martin then started a massive awareness campaign in print and web media, as well as on on radio and TV. They persuaded politicians and well-known celebrities, including star football players and children’s cartoon characters, to help spread the word about the health risks of salt.

Dr. Martin explains the success of

“If they want to influence the people, they must act like politicians. And to get the attention of the politicians, we needed the media. Without the media in Portugal, it’s not possible.”

It seems that the campaign is starting to bear fruit.

  • A recent survey showed that awareness has increased up to 75% of the population.
  • They persuaded the Portuguese Bakery Association to cooperate by coming up with a recipe that provides for lower salt content without losing taste or quality.
  • They lobbied with legislators, resulting in the passing of a law by the Portuguese Parliament that requires food labels to show salt content of food products as well as and limits the sodium content in processed foods to a maximum of 14 g/kg.

With these results, the Portuguese has set a good example to the rest of Europe and the world that health awareness campaigns do work.

Photo credit: stock.xchng

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One Response to “Battling stroke by fighting salt: the Portuguese strategy”
  1. Geeta says:

    Portugal’s PAASH campaign for mass education is indeed a valuable example of the power of media and its need in health education. As we become a technology savvy world, public health campaigns have to learn to effectively communicate their messages through the wide array of media outlets.
    The campaign though phenomenal in its reach to 75% of the Portuguese population, I would be interested in the final effects of salt restriction on the hypertension in Portugal. The moment we tag an essential mineral as the primary cause for a disease state like hypertension there is cause for concern. We did it with fats and now it’s salt. Controlled studies on the success of effective long term maintenance of salt restriction by the Portuguese and its effects on the hypertension in the country would be valuable to our understanding of salt and its effects in the human body.
    Studies show that most people are not sensitive to salt. Experimental studies of adults with normal blood pressure revealed that a salt restricted diet caused a drop in blood pressure in some but in others to rise. For the majority of cases there was negligible if any change.
    For accurate information on salt intake and health please visit

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