Cardiovascular disease (CVD) is the leading cause of premature death around the globe and around 50 percent of the cases are estimated to occur in Asia. Globally, the number of deaths due to CVD increased by 41 percent between 1990 and 2013, and this is attributed by the combination of increase in population growth and ageing populations.

Southeast Asia is currently experiencing an epidemic rise in CVD, in part due to the increasing prevalence of hypertension, a leading cause of CVD. Of the 11 countries, only Brunei and Singapore have a prevalence of hypertension below 20 percent; Cambodia has the highest (24.2 percent), and Singapore the lowest (14.1 percent). However, these percentages are still higher than that of US (13.4 percent).

THE ROLE OF HYPERTENSION IN CVD

Hypertension is a risk factor of coronary heart disease, and is the single most important risk factor for stroke—both diseases are under CVD. It has become so prevalent that it is estimated that by 2025, there will be 1.56 billion adults living with high blood pressure.

Due to the anticipated spike in patients with hypertension, it is set to become a massive burden on the economy, especially in healthcare and in the quality of life of the patient, so much so that the World Health Organisation (WHO) rates it as one of the most important causes of premature death worldwide. This is especially true for the developing nations such as Laos, Vietnam or Indonesia, wher the healthcare system is extremely stretched, and many people rely heavily on every working adult in their families to make ends meet. Just having one family member paralysed from stroke will turn their financial status downhill.

Though hypertension may be caused by some uncontrollable factors such as genetics and ageing, there are many ways in which one can reduce the risk of having an elevated blood pressure. In fact, studies have shown that high-income Asian countries like Japan, South Korea and Singapore, have seen a reduction in death related to stroke due to a decreased exposure to tobacco smoking, improvements in CVD treatment, or improvements in diet such as decreasing salt intake.

To ask an entire population to change its diet would not be feasible. Sodium alters the tastes and texture of food, and often in a negative way, therefore encouraging a lower sodium intake might be difficult. The WHO in 2012 suggested that instead of forcing people into salt reduction acceptance, food manufacturers and governments can find more creative ways such as product reformation, consumer education and creating affordable options.

For example in Japan, a nationwide approach for hypertension prevention and control has contributed to a substantial decline in stroke mortality. The most notable risk factors for stroke and coronary artery disease are hypertension and smoking, wheras dyslipidemia and diabetes mellitus are risk factors for ischemic heart disease and ischemic stroke. Strategies for hypertension prevention and control include annual systematic cardiovascular screening, referral of high risk individuals to local clinics for anti-hypertensive medication, health education for hypertensive patients at blood pressure (BP) screening sites and during home visits by public health nurses, and community-wide media-disseminated education to encourage participation in BP screening and reducing salt intake.

In Singapore, the Health Promotion Board introduced a healthier choice symbol to food and beverage products that have less fat, salt and sugar content. The board claims that seven in ten Singaporeans are aware of the symbol and 69 percent had used this symbol to assist them in making healthier food choices.

NEED FOR SALT ALTERNATIVES

There are many food and supplements including omega-3 and nuts, that are beneficial for cardiovascular health. These foods are readily available in the developed world, but people in the developing parts of Asia may experience difficulties accessing them, due to their high prices.

Apart from that, condiments rich in salt, such as fish sauce, soy sauce and oyster sauce, are a significant part of the Southeast Asian food delicacy and many consume more than the recommended average salt intake of 2,300 mg per day for the general population. Indeed, a study published in 2013 found that the salt intake in some Southeast Asian countries is as high as 4,600 mg per day.

As Asias consumers become more health conscious, and yet unwilling to give up on their traditional foods, food manufacturers now have a healthy, cost effective ingredient alternative for salt—milk and whey permeates.

WHEY AND MILK PERMEATES

Whey permeates are co-products of the production of whey protein concentrate and isolate, while milk permeate is directly from milk protein, isolate and ultrafiltered milk. Before, permeates were not very popular as consumers saw it as a form of by-product waste that did not belong in foods. In 2012 in Australia, there was even an anti-permeate movement and companies started to promote their milk products are permeate-free, causing much disappointment to the dairy industry.

Permeate itself consists of water, lactose minerals and vitamins. In general, 10-11 g of permeate will replac one gram of salt, and the usage level will vary by application, ranging from one to 10 percent in bakery products and up to 75 percent in a beverage mix.

Whey permeate has a naturally salty taste due to its nonprotein nitrogen compounds and calcium. It can be easily incorporated into a variety of foods, such as Asian condiments, reducing the sodium content by approximately 25 percent. Apart from having the usual nutritional properties of milk (calcium, zinc, phosphorus, magnesium) whey permeate has another additional benefit with regard to maintaining good hypertension levels—it is high in potassium. The increased intake of potassium from food has been shown to reduce blood pressure.

BENEFITS TO THE FOOD MANUFACTURER

Not only is whey and milk permeate a good alternative for salt, but for the manufacturers, there are many benefits as well. Reduced sodium items can be marketed to consumers using the appropriate designation which are part of the local labelling guidelines.

Other claims can be made from the beneficial minerals permeate has, for example, Source of calcium, 20 percent more potassium, and because permeates are cost effective, companies can contribute not only to the consumers good health, but can also save production costs as they do not need to use more costly salt replacers while maintaining consumers taste expectations.

The benefits of permeates have not gone unnoticed by the industry. Market research shows that the number of food and beverage new product launches that include permeate has grown at a compound annual growth rate of 64.1 percent from 2010 to 2014. Using permeates does look like a win-win situation in terms of promoting consumer health and being cost effective to the manufacturers.