In the 1960s Finland's men had the highest amount of CVD in the world and among the highest prevalence of hypertension. In the 1970s the government started a long term public health project to improve the CVD and stroke rate. Within 20 years they had brought down the number of strokes and heart attacks considerably through blood pressure reduction. They had done this by doing a public awareness campaign and by changing the amount of sodium in some of the food supply.
How Finland Reduced Blood Pressure
They used a shotgun approach utilizing both a change in food manufacture and an attempt to change lifestyle. Some of the manufactured foods had lowered amounts of sodium and an increase in potassium. Some of the sodium in table salt and the salt used in food manufacture was replaced with potassium.
There also was a public education program to try to change lifestyle. The program encouraged eating more fruits and vegetables. Along with trying to reduce the amount of smoking and alcohol consumption, the program tried to lower blood cholesterol and increase exercise.
Fewer Strokes And Heart Attacks
Twenty years later the stroke and heart attack rate was markedly reduced, and the daily sodium intake had been much reduced. Even more remarkably, the sodium to potassium ratio had improved significantly.
These improvements were achieved despite an increase in obesity, an increase in smoking in women and an increase in alcohol consumption in men. The ratio and the amount of sodium and potassium consumed still had a long way to go. And today it continues to have a long way to go. At present, the sodium to potassium ratio in Finland is about the same level as it is in the U.S.
As discussed in a 2001 article(1), the change in sodium consumption came from public education and from food manufacturers' changes. The most educated women had the greatest drop in sodium intake and greatest improvement in the sodium to potassium ratio(2).
However, the program in Finland, as in the U.S. at present, focused on reducing sodium without any emphasis on potassium. Manufacturers of table salt replaced some of the sodium with potassium, magnesium and lysine.
This helped with the initial drop in sodium consumption. But more changes will be needed to improve in the future.
Finland Still Has A Way To Go
The food group consumption pattern changed quite a bit at first. In the past 10 years it has changed only slightly in Finland. The initial improvement in blood pressure seen in the 20 year study has slowed recently, as has the stroke rate. In the early years the incidence of stroke decreased by 60%. The stroke incidence continues to go down, but now strokes are only decreasing by 13 to 23% (3).
The salt consumption went down a lot at first and then slowed. Added salt went from 3.8 gm/da to 2.6 gm/da at first, and then to 2.3 gm/da. Manufacturers of salt added some potassium salt to the normal table salt, so there was less sodium consumed even when salt was added to the food.
The main source of sodium now is from meat products. Meat products contribute a higher percentage of sodium than previously. Most meat products in Finland are manufactured products and there has not been a change in the sodium content used in the curing process of meat. Since meat is still a major portion of the food consumed, sodium from meat is the leading source of sodium in the diet.
Changes In Food Group Proportions Are Needed
After the first 20 years, there has been little change in the food groups consumed in Finland. Sausage, egg and meat products are contributing more sodium to the diet. Catered food is also contributing more sodium. The major changes in diet have been a reduction in sodium from bread, fish and fat spreads.
So although improvements are slowing in Finland, the Fins gave us the first hint at how to prevent hypertension, cardiovascular disease and strokes. Other population studies, as well as lots of basic science studies have put together a compelling story for the importance of increasing potassium and reducing sodium.
A List Of Food Tables With Potassium And Sodium Amounts
For a list of posts that includes tables with potassium and sodium content of common foods, see here.
1. J Nutr Health Aging. 2001;5(3):150-4. Nutrition and cardiovascular disease in Finland since the early 1970s: a success story. Pietinen P, Lahti-Koski M, Vartiainen E, Puska P.
2. Eur J Clin Nutr. 2006 Oct;60(10):1160-7. Epub 2006 Apr 26. Sodium in the Finnish diet: II trends in dietary sodium intake and comparison between intake and 24-h excretion of sodium. Reinivuo H, Valsta LM, Laatikainen T, Tuomilehto J, Pietinen P.
3. PERFECT Stroke PERFormance, Effectiveness, and Costs of Treatment Episodes in Stroke. Atte Meretoja, 2011