During Salt Awareness Week, Georgian health professionals share advice on the best ways to explain health hazards of excessive salt consumption to patients, and why medication for hypertension cannot be seen as an alternative to a healthier diet.
Dr Nino Chikovani, a cardiologist working in Tbilisi, explains, “When I advise my patients to eat less salt, the usual answer I get is: ‘Measuring salt intake is too much for me, it’s too complicated! To be on the safe side, I would just take some medication to lower my heart pressure.’ But this approach to problem-solving will not protect your heart. On the contrary – this puts you at greater risk.”
Raised blood pressure: a killer that can be stopped
Dr Chikovani is at the centre of the nationwide battle against hypertension, one of the most prominent health risk factors in the country. Around 40% of men and 35% of women in Georgia are living with raised blood pressure, a condition that can cause strokes, heart disease and other noncommunicable diseases (NCDs).
“Hypertension is the number one killer in Georgia, and high salt consumption is a major contributor to hypertension risk. But there is a simple yet powerful way to reduce it, and that is information,” says Dr Nina Kiknadze, a Georgian family doctor. “The more information on salt and its impact on health that a patient has, the higher the chances that he or she will make healthier choices in the future.”
Salt consumption for a healthy heart
WHO recommends consuming no more than 5 grams of salt (about a teaspoon) per day. This is among the best ways to keep blood pressure under control and protect heart health.
Today in Georgia, average salt consumption is 10 grams among men and 7 grams among women. These rates are among the highest in the WHO European Region, and are linked with the fact that cardiovascular diseases account for 69% of all deaths in Georgia. Health professionals and decision-makers in the country are in search of effective ways to reduce this health burden.
For most people, an obstacle to controlling salt intake is lack of knowledge about how much salt is in the foods they eat. At local markets, for instance, products do not have nutrition labels. Some traditional Georgian products such as cheese or bakery foods tend to be high in salt, yet many people who base their diets on these products are simply not aware of this.
We tend to forget our long-term risks
Irina Partskhaladze, who was diagnosed with hypertension a few years ago, remembers the experience of changing her usual diet: “When my cardiologist gave me advice to cut my salt intake, it was really hard to stop eating the food I’d got used to. The saltiest thing I was eating was local cheese from Tusheti region. I understood this because my hypertension medicine worked worse when I ate this cheese. But little by little, I’ve learned to better control my salt intake.”
Improving your diet is a lifesaving job
Irina says that people do not think of long-term risks, and that is why they do not think too much about their diets. She shared her views with Dr Kiknadze and Dr Chikovani during a discussion on salt-reduction strategies organized in Tbilisi by the WHO European Office for the Prevention and Control of NCDs and the WHO Country Office in Georgia in early 2023. WHO/Europe is working with Georgian decision-makers to create a comprehensive national plan to reduce salt intake and increase awareness of the hazards of raised blood pressure.
According to Georgian health professionals, there are quite a few ways to inform people on salt consumption and its links to high blood pressure. “Time is always a problem for a doctor. It would be perfect if primary-care therapists would have a special time slot of around 2 minutes for a brief dialogue on salt and heart health for each of their patients – because when you talk to patients about this, they usually listen,” explains Dr Kiknadze.
Dr Chikovani adds, “Today, younger patients usually are easier to reach out to. Many of them are interested in keeping a healthy lifestyle and are tech-savvy, so doctors can recommend some useful mobile apps for controlling salt intake.”
Strategies for reducing salt consumption – what works?
More people in Georgia want to make healthier everyday choices instead of relying just on medications, and that is a promising trend, points out Dr Kremlin Wickramasinghe, WHO/Europe’s Regional Adviser for Nutrition, Physical Activity and Obesity.
“However, people’s interest in a healthier lifestyle needs to be and should be supported by policy-makers and the industry. They can work together to reformulate foods, reducing the amount of salt added into popular products such as cheese or bread,” he adds. “Better labelling practices that keep people aware of their diets can also be effective.”
According to Dr Silviu Domente, Head of the WHO Country Office in Georgia, other ways to enhance positive trends include organizing educational programmes on nutrition and heart health in schools and other educational facilities, and running informational campaigns directed at patients at the primary-care level.
Dr Domente concludes, “To bring real change, a consolidated approach is needed where decision-makers, the food industry, health professionals and communities work together for a new environment that protects heart health for all of us.”
