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| ABSTRACT |
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| Year : 2018 | Volume
: 4
| Issue : 2 | Page : 38-39 |
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Salt – A slow poison – Salt and hypertension
Umesh Khanna1, R Ravichandran2
1 Lancelot Kidney and GI Center, Karuna Hospital and Asian Heart Institute, Mumbai Kidney Foundation, Mumbai, Maharashtra, India
2 Consultant Nephrologist, Madras Institute of Orthopaedics and Traumatology, Chennai, Tamil Nadu, India
| Date of Web Publication | 6-Dec-2018 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2395-1540.246997
How to cite this article:
Khanna U, Ravichandran R. Salt – A slow poison – Salt and hypertension. J Renal Nutr Metab 2018;4:38-9 |
According to WHO, about 9.8 million people die every year due to hypertension related complications. Hypertension is considered a silent killer producing heart disease, kidney failure and strokes. About 35% of world population above the age of 25 suffers from hypertension. One of the important strategies to lower hypertension in the population and its complications is reducing salt intake. Developed countries like Finland, United Kingdom, Australia and Canada have been actively campaigning for salt reduction in the population. In these countries, there has been a close association between government and NGO's for this purpose. Finland was the first country to show an enormous health benefit by reducing salt in the diet. Not only the population's health improves, there is also a great benefit in saving health expenditure related to heart revascularization and dialysis.
The average intake of salt in the Indian diet varies from 10-15 grams per day. There is a paucity of recent data, especially with reference to the processed food in the country. The WHO's recommendation of salt intake from all sources is less than 5 grams per day. Salt or sodium is present in natural food, it is added while cooking and also used as a preservative for processed food. Considering the rapid economic growth that is happening in our country with urbanization and increased demand for processed food, it is imperative that we act at the earliest to control salt intake of Indian population.
Salt or Sodium in various forms has been used as a preservative for several thousand years. It enhances the taste, prevents growth of harmful microorganisms and can improve the texture of food, Taste is often a habit and high salt intake can saturate the taste buds. If you lower salt intake for 2 weeks you can start appreciating low salt intake and other tastes. With the availability of refrigeration and other preserving methods like ultrafiltration, vacuum packing etc., the sodium use should come down. However this has been a responsibility of the food manufacturers who should voluntarily bring down the salt content. UK has been very successful in this aspect and the population's salt intake has dropped by 2 gms in the last decade. Sodium in various forms is used as a flavoring, buffering, anticaking, leavening, thickening and stabilizing agent. The biggest culprit is in baked goods specially bread and instant noodle.
Some of the tips to reduce salt intake are:
- Get used to low salt to allow the taste buds to recover
- Eat fresh food when possible
- Add less salt in cooking
- Not to add extra salt on table (a special problem in India since salt is served in the food plate as a routine and salt shakers for soups) and
- Use herbs and spices as flavoring agents
- It is essential to target the young college and school students and educate them
- It is a myth that Indians require more salt due to the weather and sweating
- The maximum salt lost is in urine (that's why 24 hours urine sodium is measured to calculate a person's salt intake) Sweat once acclimatized has very low sodium. Increased sweating requires more water intake and not salt
- It is also a myth that children require more salt, according to WHO children require less salt than adults.
There is an urgent need to reduce salt intake in India. There are more than 50 studies connecting salt intake and blood pressure and the benefit of reducing salt intake. Chimpanzees which live in the wild have a BP of 90/60. When they are given a diet with 10 to 15 gms of salt, their BP goes up. The Venezuelan Tribal people, who eat natural food, have a BP of 90/60 inspite of enormous stress. Over generations, due to salt consumption, the normal BP is considered 130/90. That is why atheroma and heart failure, strokes and kidney failure are seen with so called normal pressures.
By reducing the BP in any population one can reduce the incidence of strokes by 25% and heart failure by 20%. In the 1960s Japan successfully reduced the salt intake with a big government campaign. This was accompanied by large falls of BP and an 80% reduction in stroke mortality. Salt has other damaging effects like stomach cancer, renal stones, osteoporosis and asthma. In the UK the WASH was successful in setting up a salt reduction programme from the current intake of 9.5 gms a day to 6 gms. This required the development of a new policy. It involved getting the industry to slowly take out the salt across all food without the public being aware. The initial target was a reduction by 15% This has been done three times so far resulting in 40 to 50% reduction in salt in bread, cereals and other processed food. This has prevented 18,000 strokes and heart attacks. The National institute of clinical excellence in the UK calculated that for a gram reduction in population salt intake it would have saved 1.5 Billion pounds in healthcare cost per year. India of course has a long way to go. It is quite complicated, firstly because it is such a large country, secondly very diverse with very different diets.
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