Kazakhstan’s national cuisine is not complete without salt. It is in everything from kurt, a hard cheese made by drying fermented milk, to beshbarmak (“five fingers”), a dish of boiled meat with noodles, named because nomads traditionally used their hands to eat it.
“You can’t take our salty national dishes away from us,” one Kazakh tells the Guardian. “Some regions only eat salty horsemeat.”
Just one portion of lagman noodles, another popular dish in the central Asian country, contains about 5g of salt, almost the entire recommended daily intake.
In a country where people commonly eat almost four times that amount of salt a day, doctors are raising the alarm over the number of patients with strokes and hypertension.
Daulet Askenovich Kultayev’s grandmother died after a stroke earlier this year. “She loved salty dishes very much,” he says. “People in Kazakhstan consume a lot of salt. Our cuisine, in fact, consists mainly of salt, such dishes as kurt, kozhe [horsemeat with milk], beshbarmak and lagman.”
Though only 24, Kultayev had an ischaemic stroke in March, which happens when blood supply to the brain is interrupted. He had high blood pressure in the months before, but there were no other major symptoms.
His doctors, he says, blamed his stroke on his “unhealthy lifestyle, and as a result of increased salt intake”.
Complications continued after he had an operation, which took place at what is known as City Multidisciplinary Hospital No2 in Astana, the country’s capital. Six months later, he had to have further surgery to repair a skull defect caused by the previous operation.
“After the stroke, I revised my diet, reducing the amount of salt and sugar I consume, and I’ve become more active,” he says.
Dr Yerzhan Boranbayevich Adilbekov, a neurosurgeon at the national specialist centre where Kultayev was treated, says that Kazakhs consume more than 17g of salt a day on average. “That’s a lot,” he says. “There is a tradition to stock up on meat for the winter, and therefore it is abundantly salted.”
Adilbekov says that hypertension, diabetes and high cholesterol are among the most prevalent noncommunicable diseases (NCDs) in Kazakhstan – conditions that are “primarily related to lifestyle” and which are behind 87% of deaths in the country, higher than the global average of 71%.
The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a new Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
Adilbekov says people should “use ginger, lemon and other alternatives instead of salt, but this [alternative] seasoning is not widely used, particularly in the western and northern regions”.
Kazakhstan is now taking steps to reduce salt consumption. The government has developed a nutrition roadmap with the UN’s children agency, Unicef, for 2022-2025, and a working group is developing a national policy to reduce consumption of salt, sugar and trans fats. Taxes on tobacco and alcohol are also being discussed.
Laura Utemisova, who works in Kazakhstan with the World Health Organization (WHO), says “excessive consumption of salt raises blood pressure, a major risk factor for cardiovascular diseases such as heart disease and stroke, and the leading cause of death in the WHO European region”.
She says: “Kazakhstan, like other central Asian republics, has experienced a nutrition transition in recent decades and consumption of foods high in saturated fat, trans-fatty acids, free sugars and salt is widespread.”
The UN has identified salt reduction as the most cost-effective measure to prevent NCDs in Kazakhstan, she points out.
A 2017 study by WHO Europe in collaboration with the Kazakh Academy of Nutrition, measuring the salt and trans fats in homemade and street food in Kazakhstan, showed that the highest mean salt content in a serving was found in homemade noodles (5.6g), plov (5.2g) and kebab (4.3g), with portions corresponding to 112.4%, 104.2% and 85.4% of the recommended maximum daily salt intake respectively.
“Food labelling requires indication of salt content per 100g on food packaging but due to low knowledge of high salt intake consequences among the population, this measure has no effect,” says Utemisova.
“Therefore initial steps have been taken by the working group on nutrition to implement food labelling in Kazakhstan that complies with WHO recommendations to inform consumers on products with high salt, sugar and fats content.”
NCDs are an increasing public health challenge in Kazakhstan, and cardiovascular diseases are the main driver of premature mortality in the country, Utemisova says.
“Estimates indicates that 26% of adults have raised blood pressure and 12% have diabetes,” she adds.
One issue is that in order to promote small and medium-size businesses, the government is granting them exemptions from state supervision, which means to make their products cheaper, they are using more salt, sugar and fats.
Utemisova says it is important for campaigns to target women, because decisions on what to eat are often made by them.
“In Kazakh tradition, we eat homemade food and the prerogative of cooking is given to women, except for a few regions with influence from Uzbekistan, where the culture says that cooking with meat is for men only.
“However, mothers are the ones who cook for their families and buy groceries. Therefore, in most cases, it is the choice of women how to cook – and accordingly how much salt.”
• Two names in this article were reordered on 13 December 2022, with the family name (rather than the patronymic) now appearing last for Daulet Askenovich Kultayev and Yerzhan Boranbayevich Adilbekov.
