In our obsession to eliminate fats, sugar and carbohydrates from our diet, we forget about the ubiquitous salt, which is present in almost everything we eat that is not raw.
It’s easy enough to shun sugar: all you have to do is skip dessert, switch to unsweetened beverages and go easy on sweet fruits that have high amounts of natural sugars such as fructose. Those who need a 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 the body. In middle and upper-middle class homes, over 50 per cent of salt comes from “hidden” sources such as processed foods, be it breads, processed meats, cheese, biscuits, cookies, cakes and packaged munches like chips and namkeens. Saltiness is not an indicator as salt is added to everything to enhance taste, give texture and bind in water, which helps add bulk to a product.
Your body needs some amount of salt, of which between 1 and 1.5 grams comes from food naturally. The added intake, says the World Health Organization, should not be no more than 5 grams —about one level teaspoon — a day. “The most recent survey — the Chennai Urban Rural Epidemiology Study published in the Journal of Association of Physicians in India in 2007 — shows that people have an average of 8.5 grams of salt a day. People who eat processed food should eat even less because of the high salt content in junk food,” said Dr Sushum Sharma, senior consultant in internal medicine, Max Healthcare, who is also a member of the Indian Guidelines for Hypertension-2, and provided inputs for section on salt intake.
Hold the salt, please
Excess salt increases causes water retention, adding at times up to a litre of water in the blood vessels. Apart from making you appear bloated, it puts pressure on the heart by adding to the blood volume, raising blood pressure.
“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,” said Dr J N Pande, senior consultant of medicine at New Delhi’s Sitaram Institute of Medical Sciences. His review of data from reports of 1,701 healthy people (637 women and 1064 men) — published in the Annals of the National Academy of Medical Sciences in 2009 — who underwent executive health checkups at Sitaram Bhartia Institute showed uniformly high salt levels.
According to the British Medical Journal’s review of studies covering over 170,000 people, keeping salt intake to the recommended 5 grams a day reduces strokes by 23 per cent and heart disease by 17 per cent.
The World Heart Federation estimates that reducing salt intake to 5 grams a day would prevent 1.25 million stroke deaths and 3 million deaths due to heart disease each year.
“Cutting back on processed foods is an easy way to monitor salt intake. Once the salt in your food goes down, so will your blood pressure,” says Dr Pande.
Nutritional labels on packaged foods often mislead consumers. “Nutritional labels list the sodium, not salt content, which is always higher. To get the salt content in a packaged food, multiply the sodium value by 2.5,” says Dr Pande.
In the US and UK, 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 per cent reduction in the overall salt intake. 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.
Try to cut back on salt, not replace salt with other options. “Commercially-available low-sodium salts are high in potassium and are not very safe for people with kidney disease or for those on medications that conserve potassium, such as certain diuretics, ACE inhibitors and angiotensin II receptor blockers prescribed for high blood pressure, kidney damage due and heart failure,” said Dr Sharma.
Low salt intake by this group can lead to a severe electrolyte imbalance that may require hospitalisation.