Grains of salty truth

Kidney disease in Thais has reached alarming levels – so why are we still dousing our food in sodium?

Along with countries all over the world, Thailand is marking World Kidney Day on Thursday with the unwelcome news that more than 8 million people here – a massive 17.6 per cent of the population – are suffering from chronic kidney disease. The culprit behind this depressing figure can be summed up in four letters: S-A-L-T.

Thais, it seems, are addicted to sodium, even dousing a plateful of healthy vegetables in such salt-heavy additives as fish or oyster sauce and discreetly pouring the white grains to the sides of their fruit plates.

Dr Anutra Chittinantana, president of the Nephrology Society of Thailand, explains that kidney disease is designated as chronic when a patient’s renal function works at less than 10 per cent over a period of three months. He also notes that people tend to consult a doctor much too late, usually when the disease reaches the stage when they can’t recover,

“All we can do is treat the functional loss process through medication and dialysis,” he says.

The current figures for kidney disease in Thailand make for depressing reading. According to Dr Anutra, more than 200,000 patients are in the last stages of chronic kidney disease and 40,000 of them are waiting for kidney transplant. Unfortunately, only 400 patients can get a kidney transplant every year.

The director general of Public Health Ministry’s Health Department, Dr Pornthep Siriwanarangsan, adds that the Thai government today spends as much as Bt3 billion on kidney patients a year under the universal health-care scheme, which was expanded in 2008 to include financial help for renal replacement therapy for patients in the end stage of kidney disease. Renal replacement therapy is expensive, he stresses, with the cost of haemodialysis for one individual topping Bt400,000 per year.

And the problem could be largely avoided if we didn’t insist on consuming so much salt. Studies undertaken all over the world have shown that consuming goods high in salt can cause kidney disease and is a major contributor to high blood pressure.

It’s not only cooking with or adding salt to our food that’s the problem. While sodium chloride makes up 40 per cent of table salt, it’s also found in large quantities in fish sauce, seasoning sauce, oyster sauce, monosodium glutamate as well as in baked products and soft drinks, which contain sodium bicarbonate.

Founded in 2012, the Low Salt Thailand Network continues to actively promote a low salt diet, albeit with mixed results.

Its chairman, Dr Surasak Kantachuvesiri, says the campaign has been aggressive in targeting both consumers and product manufacturers.

“The manufacturers are interested in cooperating but are worried about the risks to their profits, as consumers don’t seem overly concerned about their salt intake,” he says.

Indeed, the consumers’ attitude to salt is proving the biggest obstacle to the campaign.

“Their taste buds have become used to a salty taste and they find any food without salt bland and tasteless,” he says.

“Young and healthy people tend to think ‘it won’t happen to us’ and refuse to be deprived of their sodium kicks. They will only realise the risk 10 or 15 years down the line when they face health problems or if a family member develops chronic kidney problems.

“One way that can help is to change their environment, which means convincing the product manufacturers to release more low-salt products and in the meantime provides more low-salt

recipes to restaurants, food stalls and canteens.

In this the network has seen some success. More low- salt or low-sodium products can be seen on supermarket shelves. Certain manufacturers have also reduced salt content in their products.

Research undertaken at Kasetsart University’s Institute of Food Research and Product Development has led to the introduction of low-salt but great-tasting Thai dishes and soups. Mahidol University’s nutrition institute meanwhile is working on healthy food guidelines and its engineering faculty is finishing a salt meter product that can help kidney disease patients test food salt levels before eating.

“And we consume salt twice with every meal,” Dr Surasak says. “The first time is when we season the ingredients during the cooking process, while the second is when we add sauce and condiments at the table.”

Dr Anutra adds that kidney disease patients should worry far more about salt intake from food and stop attempting to blame their sodium levels on salty tap water.

The recent build-up of seawater in the Chao Phraya River led to salty tap water warnings but and Dr Anutra points out that the risks are very low, not least because most Thai people don’t drink tap water.

“We drink filtered or boiled water, and the process can reduce much salt from the water. Even if we were to drink the tap water, we’d have to consume a huge amount for it to have any effect,” he says.


  • Your recommended daily intake of sodium shouldn’t exceed 2,000mg per day – one teaspoon – equivalent to five grams of salt.
  • One tablespoon of fish sauce contains 1,160 to 1,420 mg of sodium.
  • One tablespoon of soy sauce contains 960 to 1,420mg of sodium/
  • One tablespoon of seasoning sauce contains 1,150mg of sodium.
  • One tablespoon of oyster sauce contains 420 to 490mg of sodium.