By Dr. Johanes Chandrawinata, MND, SpGK BANDUNG
Low Sodium Diet
Low Sodium Diet lower blood pressure 15% reduction in salt consumption avert up to 8.5
million deaths in 23 high-burden countries over 10 years Suggested global goal: reduce worldwide salt intake to ≤ 5 g (or 2000 mg sodium)/person/day by 2025
Flow Mediated Dilatation , Systolic BP, & 24-h Sodium Excretion Significantly Different
Low Sodium Diet Problem: Palatability ???
The Study by Ball et al Objective: To ascertain (1) whether the taste characteristics of a conventionallysalted (150mM NaCl) soup can be reproduced in soups of substantially lower NaCl level with the help of added glutamate (2) whether calcium diglutamate (CDG) is equivalent to monosodium glutamate (MSG) in its effect on the taste of soup.
Ball et al Conclusions Addition of glutamate allows substantial reductions in
Na content of soup, without significant deterioration of taste. CDG and MSG have equivalent effects, but use of CDG permits a greater reduction in Na intake
Question: Is MSG Safe ?
What is MSG ??? MSG Composition
(MONOSODIUM GLUTAMATE) (C5H8O4NNaH2O)
Natrium 12%
Free L-Glutamate 78%
“Free Glutamate” Taste: Umami Naturally Occuring in every living organism
Water 10%
GLUTAMAT dalam tubuh manusia Study Bioassay
70kg Tubuh 1) Menyimpan 1400g Glutamat (bebas & terikat)
Glutamat : 180 mg/100g ASI (50% total protein ASI)
2) Produksi 41g/hari Glutamat bebas Survey
Glu Terikat dari Makanan
Glu Bebas dari Makanan
Glu Bebas dari MSG
Total
USA
10,0g/orang/hari
1,0g/orang/hari
1,0g/orang/hari
12,0g/orang/hari
1,9g/orang/hari
15,9g/orang/hari
Jepang
14,0g/orang/hari
Glutamat Bebas Didalam Makanan Sehari-hari Sayuran Kol Bayam Tomat Asparagus Hijau Jagung Green peas Bawang Bombay Kentang Jamur
(mg/100g) 50 48 246 49 106 106 51 10 42
(K. Ninomiya 1998)
(mg/100g) Keju Camembert 40 Keju Chedar 182 Keju Emmental 308 Kecap Cina (soysauce) 926 Kecap Ikan Thailand 950 Saos Tiram 950 Terasi segar (Indonesia) 1199
(mg/100g) Scallop 140 Kepiting raja alaska 72 Daging Ayam 22 Daging Sapi 10 Udang putih 20
MSG & Isu-Isu Kesehatan JANIN (1979) CHINESE RESTAURANT SYNDROME (1968) KEBOTAKAN
2010
1908
KERUSAKAN OTAK (1969) KANKER (1977)
dr. Robert Ho Mann Kwok
The New England Journal of Medicine 4 April 1968 Gejala-gejala aneh setelah memakan makanan Cina yang hilang dengan sendirinya setelah sekitar 2 jam
Natrium/Garam
Angciu/Rice Wine
MSG
Kecap asin
Tidak ada pengukuran paramater kesehatan, misalnya tekanan darah atau test darah
Penelitian Widharto et.al. (2000) Metode: Randomized, Double-blind, Crossover, Placebo Control Subject: 52 Orang Gejala
Placebo
1.5 g MSG
3.0 g MSG
Pening
14
12
13
Pusing
3
4
2
Kaku di leher
7
2
6
Berdebar-debar
3
3
1
Lesu
18
12
19
Rasa nyeri di dada / terasa terbakar
5
0
5
Kembung
6
3
2
Mual
1
13
4
Haus
0
1
0
Safety of MSG 1987 : JECFA
1991 : European Union 1958 & 1995: USFDA (GRAS)
1988 : Peraturan Menteri Kesehatan Indonesia 2007: Hohenheim Consensus 2012: FDA Denial Letter to a Petition ADI NOT SPECIFIED
MSG & Kerusakan Otak ? Selama sawar darah-otak utuh, tidak ada resiko GLU
melewati sawar Pada kondisi tertentu seperti lesi sawar otak dan anestesi dengan obat isoflurane dapat mempertinggi masuknya GLU ke dalam otak Sampai saat ini belum ada bukti ilmiah yang menunjukkan keterlibatan GLU tambahan dalam menimbulkan penyakit syaraf
MSG & Kanker ? GLU toksisitas sangat rendah dalam kondisi normal Dosis oral lethal terhdap 50% subyek pd tikus &
mencit: 1500 – 1800 mg/kg BB Penelitian toksisitas subkronis dan kronis sampai 2 tahun pd tikus dan mencit : tidak ada efek samping sampai kadar 4%
MSG & Kanker ? Penelitian reproduksi dan teratologi melalui route
oral tidak ada masalah janin dan bayi menyusui tidak terpapar pd kadar GLU yang toksik dari makanan ibu nya melalui transfer placenta
MSG dan Janin Walau pada kadar yang sangat tinggi, GLU tidak akan
masuk kedalam sirkulasi janin Karena itu, GLU dalam makanan tidak mempengaruhi pertumbuhan janin
decades of research have failed to demonstrate a clear and consistent relationship between MSG ingestion and the development of these condition
“MSG or glutamate via intraperitoneal or subcutaneous injection” FDA does not consider them to be relevant to the effect of MSG or glutamate-containing ingredients that are ingested as food …
Route of administration should approximate that of human exposure
Fate of MSG in the Intestine Undergo rapid metabolism in intestinal lumen
limiting the amount of Glutamate entering the blood 95% ingested Glutamate is metabolized Oxidized as energy source
Non-oral routes were not designed to investigate the safety of MSG, but to examine biological functions that involve endogenous glutamate The ability of glutamate to induce hypothalamic damage & resulting obese phenotype is rodent-model phenomenon not observed consistently in other species, like dogs or non-human primates
Prenatally exposed rats to 2.5 or 5 grams of MSG per day were found to have lower birth weight & lower serum GH ?
MSG & GH Dose 5 gram/day in 250 gram mouse = 20 gram/kg
BW/day US intake of MSG 0.38-0.51 gram/day/person or 2,900 times lower than the study in mouse Primate models would be more appropriate Variability in sensitivity to MSG between species
Oral MSG amplify glucose-induced insulin secretion triggers obesity ?
FDA response The study: bolus 10 grams MSG + 75 grams glucose Glutamate level rises protein induces insulin
secretion MSG is still GRAS
Take Home Messages Low Sodium Diet is recommended for the treatment
of hypertension The palatability of low sodium diet can be increased by adding MSG or CDG to the food MSG is safe for consumption as it is classified as GRAS food additive group
Dr. Johanes Chandrawinata, MND, SpGK Melinda Hospital Bandung
