2013

In 2013, the WHO reviewed salt reduction activities across the European region and produced the report 'Mapping salt reduction initiatives in the WHO European Region'. Below is a summary of salt reduction activities in Bulgaria, as reported in this document:

Between 2005 and 2010, reformulation of food to reduce salt content was a key priority of the first National Food and Nutrition Action Plan. The Action Plan aimed to decrease salt consumption and taxation was implemented by the Ministries of Health and Finance in 2005-2007.  In 2009, an ordinance was implemented in schools which mandated the reduction of salt content in all school canteens. The ordinance was updated for 2011–2012 to include provisions for healthy nutrition and salt reduction in kindergarten canteens.

A national survey in 2004 found that salt intake was between 12.5-14.5g/day for men and 11.4-16.6g/day for women, which was based on 24-hour dietary recall. In 2011-2012, salt targets were established for bread, milk and lutenica (a vegetable relish).

Two press conferences have been organized at a national level regarding the National Food and Nutrition Action Plan. A new national public awareness campaign on salt reduction was planned to start in 2012.

The 2012–2017 National Food and Nutrition Action Plan aims to include a sodium content analysis of ready meals and basic target foods. Monitoring of nutritional status and dietary intake, including an analysis of sodium excretion in 24-hour urine samples in population subgroups, is also intended under the new Action Plan.

2011

Legal maximum salt levels exist in Bulgaria for the following products:

• 3 types of flour and 3 types of national bread: ≤ 1.2 g salt/100 g bread
• Bulgarian white cheese - white cheese in brine: 3.5 ± 0.5% salt
• Bulgarian yellow cheese - yellow cheese “Kashkaval”: 1.8-3% salt
• Meat and poultry products: ≤2 g salt/100 g
• Durable boiled smoked sausage: ≤ 3.5 g salt/100 g
• Lutenica: ≤1.7 g salt/100 g

February 2009

WASH OR CASH

A Bulgarian message in World Salt Awareness Week (2 – 8 February, 2009)

George N. Chaldakov, MD, PhD
Chairman, Bulgarian Society for Cell Biology
Division of Cell Biology, Medical University, Varna, Bulgaria

Think globally, act locally.
René Dubos (1901-1982)

In February 2008, Dr Steven Feinstein from Rush University Medical Center, Chicago, IL, USA wrote in the Preface of his book Non-invasive surrogate markers of atherosclerosis that:
"An aging, overweight, sedentary baby boomer population is under siege. Approximately 58 million people die from cardiovascular diseases each year, nearly 1.2 million from heart attacks and 700,000 from strokes in the United States alone."

I would like to added that nearly 70,000 people die from cardiovascular diseases each year in a country of less than 8 million population like Bulgaria, as also alarmed in our paper Homo obesus Bulgaricus published in CV Network Online, volume 6 (3), 2007.

Indeed, through strokes and myocardial infarctions, the high blood pressure (hypertension) is one of the biggest cause of death worldwide. According to the calculations of the World Hypertension League, if salt intake is reduced by half it would save approximately 2.5 million people a year dying unnecessarily of strokes, myocardial infarctions and chronic kidney diseases worldwide.

World Action on Salt and Health (WASH) and Consensus Action on Salt and Health (CASH) are global organizations with the mission to improve the health of populations throughout the world by achieving a reduction in salt intake. WASH’s membership includes 80 countries, Bulgaria being represented by the Bulgarian Society for Cell Biology, the Varna Direction of Public Health and the Medical University of Varna.

World Salt Awareness Week (2-8 February 2009) initiated by WASH was organized in 28 countries including Bulgaria, particularly city of Varna. While the Week’s major message was "Salt and eating out", here we focused on "Salt and eating in and out", thus urging people to ask for less salt in their food eaten both at homes and restaurants. We also encouraged the food industry to reduce the amount of salt it adds to foods, also chefs in restaurants to add less salt to their food as they cook. And advised them to read Morgan Spurlock’s book Don’t eat this book. Fast food and the supersizing of America and watch his documentary movie Super size me (where the animation is made by Bulgarian-American artist Svilen Dimitrov).

"Add less salt during the cooking stage and let people add more at the table if they want to. After all, no cook would dream of adding sugar to someone’s coffee or tea without asking them – why don’t they give people the same chance when it comes to salt?", says Katharine Jenner, WASH Coordinator.

Accordingly, World Kidney Day will take place on 12 March, 2009, and World Hypertension Day on 17 May, 2009, the latter focusing on "Salt and High Blood Pressure: Two Silent Killers".

At the level of the causal link between high salt intake and high blood pressure, the world-famous monologue "To be or not to be, that is the question" in William Shakespeare's Hamlet (Act III, Sc. I) can be expressed as: "WASH or CASH, that is the question." Meaning: to "wash" the excessive amount of salt circulating and stored in our bodies or to “cash” (pay) with an increasing mortality from stokes and myocardial infarctions. Ultimately, we must "take arms against a sea of troubles" derived from high salt intake-high blood pressure paradigm!

Epilogue

"Carthago delenda est!" (Carthagen must be destroyed!), used to say Marcus Porcius Cato the Elder (234-149 BC). Indeed, that was happened in 146 BC. It was said that Romans covered Carthagen's land with salt, to stop growing of any plants there. Traditionally, the Bulgarian food is "covered" with salt, hence we are the sadly champions in stroke mortality worldwide. The collaborative efforts of physicians, biomedical scientists, state, and media are an urgent task in Bulgaria. The nation to at long last smile more optimistically. And healthy!