How much salt should I eat? It’s a question most of us ask physicians when our blood pressure creeps up and we are forced to acknowledge we can’t live forever. Use added salt as little as possible because sodium, the active component of salt, is present in almost everything we eat that is not raw.
Our body needs some amount of salt, about 3 gm each day, of which between 1 gm and 1.5 gm from food naturally. The added intake, says the World Health Organization, should not be no more than 5 gm – about one level teaspoon – a day.
A typical Indian diet contains between 8.5 gm and 10 gm of salt a day.
It’s easy enough to shun sugar: all you have to do is skip dessert, switch to unsweetened beverages and go easy on sweet, fleshy fruits such as mangoes that are high in natural sugars such as fructose. And those who absolutely who can’t do without their daily sugar fix have the option of replacing sugar with zero-calorie artificial sweeteners.
Cutting back on salt is far more difficult. Unlike sugar, salt finds insidious ways of creeping into your body. Saltiness is not an indicator as sodium is added to most processed and packaged food, including breads, to enhance taste, give texture and bind in water, which helps add bulk to a product.
In middle and upper-middle class homes in India, more than half of the total salt consumed comes from hidden sources such as processed foods, be it breads, processed meats (cold cuts and sausages), cheese, biscuits, cookies, cakes and packaged munches like chips and namkeens.
Some amount of sodium is needed to maintain the body’s fluid balance, transmit nerve impulses and help muscles contract and relax. The kidneys balance the body’s sodium level, holding on to it when blood levels fall and excreting it when the levels are too high. But when sodium remains high, the kidneys can’t pump it out fast enough. Excess sodium causes water retention, at times adding up to one litre of water to the blood volume in a day, making the heart work harder and increasing pressure in your arteries.
Apart from making the body appear bloated, the added blood volume raises blood pressure, leading to higher chances of heart attack, stroke, congestive heart failure, cirrhosis and chronic kidney disease. One in three adults in urban India and one in five in rural India have chronic high blood pressure, which is a risk factor for heart disease and stroke, which are the leading cause of death in India.
According to a BMJ review of studies covering over 170,000 people, keeping intake to the recommended 5 gm a day worldwide reduces stroke by 23% and heart disease by 17%. The World Heart Federation estimates that reducing salt intake to 5 gm a day would prevent 3 million deaths due to heart disease and 1.25 million stroke deaths each year.
Complicating the problem further are nutritional labels on packaged foods that are designed to mislead consumers. Nutritional labels list the sodium, and not the salt content, which is always higher. To get the salt content in a packaged food, multiply the sodium value listed by 2.5. Foods with less than 120 mg per 100 grams are low in salt, while foods with more than 500 mg are high in salt.
In several developed countries, the food industry is working with government on a voluntary basis to get salt content in packaged food down, which has led to about a 10% reduction in the overall salt intake over five years. But it’s not enough, as people need to cut back on consumption by a third. In India, while some companies do offer low-salt variants of snacks – such as namkeens or chips – the sodium content in them still remains high, with one packet of namkeens often containing twice your recommended amounts of salt.
Replacing salt with commercially-available low-sodium salt options is not a healthy option for most people. These, say experts, are high in potassium and are not very safe for people with kidney disease or for those on commonly-used medicines to conserve potassium -- such as certain diuretics, ACE inhibitors and angiotensin II-receptor blockers -- prescribed for high blood pressure, kidney damage due and heart failure. Low salt intake by this group can trigger severe electrolyte imbalance that may require hospitalization to fix.
Home-cooked meals are the healthiest option, and before you know it, your tastebuds may be re-trained to accept unsalted food as palatable.