Policy change pushed to cut sodium in food products

DETECTION Participants of a forum on the health impacts of sodium held recently at St. Luke’s Medical Center in Quezon City get their blood pressure checked and undergo a urine albumin-creatinine ratio test to detect possible signs of kidney damage. —PHOTO COURTESY OF IMAGINELAW

MANILA, Philippines — Before developing chronic kidney disease (CKD), CJ Luis usually settled for any packed food he could grab from the store as he was often too tired to cook after working the night shift in a business process outsourcing (BPO) company.

He got by on mostly quick but fatty fare, with little to no vegetables. But after being diagnosed with stage 5 CKD at age 30—and getting a kidney transplant at 35—he now makes an effort to prepare his own meals, throwing in fruits and greens—and keeping processed food out of the menu.

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The fast food cravings are still there, but “it’s only once a week or once every two weeks, because we all know the amount of salt is high and it really isn’t healthy,” Luis told the Inquirer.

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READ: WHO study bares bitter health impact of excessive salt use: Deaths, diseases

Fighting the food culture

One Filipino develops CKD every hour, according to latest available data. And at this alarming rate, mere public campaigns or reminders to be more mindful of one’s diet may no longer be enough, according to nutritionist Jeline Marie Corpuz of the global nonprofit Nutrition International.

The food environment itself—the very choices available on the grocery shelves—should change and make it easier for consumers to find healthy meals, Corpuz said.

She urged the public to support the implementation of a national sodium reformulation policy, which would compel food manufacturers to gradually reduce the sodium content of their products.

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READ: Salt tax? Why not healthier food, says group

“It is really hard to cut off [salty foods] because it is part of our culture. So, an important thing that should happen is the food that is available—the soy sauce, the fish sauce—its sodium content should be low,” she said during a forum held on June 24 at St. Luke’s Medical Center, Quezon City.

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7M with CKD

CKD is mainly marked by kidney damage or low kidney function lasting more than three months, according to Dr. Rachell Ann Siute, a nephrologist also at St. Luke’s.

Citing 2021 data, Siute said more than 7 million Filipinos were diagnosed with the disease that year; while in 2022 almost 105,000 were undergoing dialysis—compared to just 5,000 recorded in 2008.

One way to prevent CKD is to avoid food with high salt content, as sodium causes water retention in the body, which then leads to increased blood pressure, eventually damaging the blood vessels in the kidneys and affecting their function.

The World Health Organization recommends a daily sodium intake of just 2 grams, or about one teaspoon, Siute said.

While people age 60 and above have a higher risk of CKD, Corpuz said, many younger Filipinos are becoming vulnerable due to unhealthy eating habits, with fast-food chains and convenience stores being their go-to options.

“The youth … are increasingly consuming prepackaged meals because that [option is easily in] their environment,” she said. “Nutrition education is not enough. Knowing that this food is bad for you is not enough. The food environment really needs to change.”

Focus on food products

Five bills seeking sodium reformulation in the local food manufacturing industry have been filed in Congress as of April.

Corpuz called on the public to make both the government and business community feel that there is demand for such change.

The pending measures include House Bill No. 6334 or the “Iwas Alat, Iwas Sakit Act,” which calls for the adoption of a “stepwise approach” or the gradual reduction of sodium in food products. This would allow consumers to adjust their taste buds while giving manufacturers enough time to reformulate their products.

HB 6334 covers all food business operators involved in the production, manufacturing, importation, distribution, supply, advertisement and marketing of prepackaged food in the country.

Under the bill, the Department of Health (DOH) and the Food and Nutrition Research Institute of the Department of Science and Technology (DOST-FNRI) are tasked with gathering data on sodium consumption patterns of Filipinos to establish a Sodium Data System.

The system will help identify “high-impact food categories” or the prepackaged food products that put the most sodium in the everyday Filipino diet. Once these items are identified, the DOH will prescribe a maximum sodium limit per food category.

Monitoring sodium content

Once the cap is set, food business operators will be given a grace period of less than a year to comply. Afterwards, they may no longer manufacture, import, distribute or sell a product whose sodium content exceeds the limit.

The Food and Drug Administration may suspend, revoke or cancel the certificate of product registration of noncomplying companies, and their products will be seized.

The bill penalizes large companies with fines ranging from P500,000 to P10 million. Medium, small, and micro enterprises will be fined P5,000 to P50,000.

“For decades, the responsibility of healthy eating has rested unfairly on individuals, as prepackaged and processed foods quietly exceed global sodium benchmarks, shaping consumption patterns long before a Filipino decides what to eat,” said Albay Rep. Carlos Andes Loria, the bill’s principal author.

“The Sodium Reformulation Bill changes this paradigm. It shifts the burden from the consumer to the institutions that shape our food environment—from individual willpower to collective accountability,” he added.

Citing data from the DOST-FNRI, Corpuz said among the top contributors to high sodium intake among Filipinos are instant noodles, traditional fermented sauces, dried and processed food products, wheat and egg noodles, butter and margarine, cheese, crispy cereal chips, salted eggs, and alcoholic drinks.

Notably, the list also included food that does not actually taste salty but still high in sodium, such as white bread and the breakfast pastry “pandesal,” as well as chocolate-based beverages.

‘Healthy options’

It’s important to always check a product’s nutritional label to accurately see just how much sodium it contains, Corpuz said.

But ultimately, she said, “Our environment should be the one providing us with a healthy option so we would not have to think too much if this has a lot of sodium, a lot of sugar. It is important that the options in the market are already healthy so that the burden is not on us.”

Luis, the CKD sufferer, is also a member of Dialysis PH, a patients’ group supporting the adoption of a sodium reformulation policy.

He believes that such legislated, industry-wide improvement would provide a “targeted” approach to stemming the CKD tide.

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“Once sodium reformulation becomes a law, even if [prepackaged] foods or canned goods remain the affordable [option], it will help reduce the number of people who develop CKD,” he said. /cb