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Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 73-75

Salt a slow poison (speech verbatim SRNMCON 2018)

Chairman, Sapiens Health Foundation, Director, MIOT Institute of Nephrology, Chennai, Tamil Nadu, India

Date of Web Publication23-Apr-2019

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jrnm.jrnm_8_19

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How to cite this article:
Ravichandran R. Salt a slow poison (speech verbatim SRNMCON 2018). J Renal Nutr Metab 2018;4:73-5

How to cite this URL:
Ravichandran R. Salt a slow poison (speech verbatim SRNMCON 2018). J Renal Nutr Metab [serial online] 2018 [cited 2020 Jul 16];4:73-5. Available from: http://www.jrnm.in/text.asp?2018/4/3/73/256826

Salt a slow poison. Why should salt be a slow poison? Slow poison is one which acts over years. It kills you without your knowledge. You are not even aware that you are getting affected by it. Salt is a very ancient substance discovered 7000 years back. Salt was found as a preservative, not for taste. If you do not put salt, food will not last, it will ferment and decompose. Hence, salt was used as a preservative. Man used to hunt for fishes when the weather was good, and in winter season or rainy season, he had to preserve that food to eat. So, they discovered salt. If you put fish in salt solution, it would last for long, it was called brine. So, the fish was stored in brine to eat it during winter months. It is a very strong preservative. It kills bacteria. It was an important substance in those days; the Romans used it as a salary. People were given salt bag for their work. The word salary itself was derived from salt. There was a salt tax for some time. It was even used as a currency.

Why should we then now look at salt in a different way? Which is the most common killer in the world if I ask you? Hypertension, high blood pressure, and its complications. Heart attacks, strokes and kidney failure. 9.8 million people die every year. This is a WHO figure.

Tension and stress are blamed by lay people for hypertension. You say the blood pressure has shot up. What you are talking is anxiety. Only transiently your blood pressure goes up. Tension is different from hypertension. What puts up the blood pressure, the most common cause is the salt intake. The more salt you take the more is your blood pressure. I will show it to you little later, how the blood pressure of human beings was very low and now it has become 130/90. Hence, salt intake is the number one reason for high blood pressure. Salt refers to sodium chloride. Now, potassium has the opposite action of sodium. So, if you take more potassium, your blood pressure drops. Potassium is there in fruits, vegetables, coconut water, and juices. Higher your weight, higher is your blood pressure. This is very important. Obesity is a big problem even among students. According to our survey, about 28% of the male students between 18 and 22 have obesity; they have a body mass index which is more than 25. In women, BMI >25 in this age range is only 14% which is due to lack of exercise. If you do not exercise, your blood pressure remains high. Alcohol excess can also produce high blood pressure.

This is the tribal man. He is from the Venezuelan tribe in South America. Now, his blood pressure is only 90/60. He hunts every day, he runs 18 km, he has stress throughout the day, he can be killed by animals, he does not have a proper safe house, he is always worried, and still his blood pressure is only 90/60. That is because he is not aware of salt. He is not taking salt at all in his life. He eats only natural food. His blood pressure is 90/60. These are the gorillas. The gorilla in the wild has a blood pressure of again only 90/60. The same gorilla you put it in the zoo and feed the human food, blood pressure goes to 140/90 which we call the upper limit of normal.

Salt intake in India: how much salt do we take? There are not many studies in India, but whatever studies have been taken, we take about 10–15 g of salt per day. This is salt which is present in natural food, salt which is added during cooking, and salt in preserved food or packed food. Even sweets contain salt, for example, biscuit, also has salt as a preservative. Otherwise, the cake or the bread will not last. If a bread is made in a company, and it is sold in the shop, and you eat it, it requires to stay for 7 days at least. So how do they preserve it? They preserve it by adding salt. Hence, salt is present virtually in so many forms in our diet and the average intake of salt in India is 10–15 g. There was a study from Andhra which of course was not very properly done. It calculated the total amount of salt taken by the family, bought by the family, divided by the number of days, divided by the number of people, and they come to the conclusion that Andhra people were taking about 30–35 g of salt per day. Hence, there is a huge intake of salt in this country depending on the culture, depending on the practices, and of course the present habit of eating preserved food or eating food outside. Which is the highest salt content in the Indian food, snacks that you eat? Instant noodles. Instant noodles have a very high salt. Even your white bread has, but instant noodle has the highest. Obviously, pickles have a very high salt content because they have to stay for long. The best way to know how much salt you are taking is the measurement of 24 h urinary sodium.

Hence, there are number of myths that salt is a must for tasty food. Majority of people will feelthat they require salt, and without salt they cannot eat. But mo, it is not necessarily so. If one stops taking salt, after 2 weeks, the taste buds will recover. One will start appreciating very low salt. as well as other flavors. I want to bring out the flavor of the vegetable, I want to bring out the flavor of the meat, I want to bring out the flavor of pepper, so many other items. So, salt is a dominant taste like sugar. If you put salt, it can kill all other tastes. You will not appreciate other tastes if you increase salt. You can make tasty food with low salt. I will not say salt-free. Salt-free is very difficult. You will not be able to achieve. Because from birth, we have been taking food with salt. So, at least, if you lower salt, you will start appreciating other flavors. Salt substitute is safer and -there are number of salt substitutes in the market. They are all potassium chloride added into it. Hence, they are reasonably safe provided you do not have kidney problem. Children require more salt ÷ this is wrong. Actually, children require less salt. In the first year of life, unfortunately even pediatricians are not aware that no salt should be given to the child. Now, worldwide, they do not give salt in the first year of life. Only in India, I see the practice that the grandmother prepares something, adds a little salt to it, and gives it to the child. The recommendation by the WHO is you do not give salt in the first year of life and gradually come to the adult intake by the age of 12 years and the recommended adult intake is only 5–6 g/day, which is one-third to half of what we are eating now. What we are eating is definitely in excess. The result is that as college students your blood pressure should be how much? 100/70, 90/60. However, you will be surprised when you record it, now it will be 120, 130/80. Hence, it is already gone up. By that time, when you are 30, you are back into life, your blood pressure has shot up and then you get into future complications, kidney disease, heart attacks, and strokes. This is the reason why we need to reach up to the youth. More salt is required in hot weather due to excessive perspiration. No sweat has been analyzed. Sweat contains very low sodium. So if you sweat more, you require to take more water, not more salt. If you take more salt, you can get high blood pressure. So you take more water.

So, the WHO recommends 5 g of common salt or sodium chloride per day from all sources. All sources include, natural food, salt added during cooking and preserved food. 5 g of salt is equivalent to one tea spoon of salt. So, it is mistaken by some people that they are allowed extra 5 g. It is not so, from all sources.

There are five ways about how to reduce or control your salt intake. A very difficult challenge. We have been used from childhood to take so much salt. Now if I tell you to reduce salt it is not possible. If you put it in the mouth, you tell this food is very bad, throw away. So how do you reduce salt? So it is a habit. It is a practice. So you should try to eat as natural as possible. That will help you. Don't eat refined salt. Try to use other spices such as chilies and pepper. Try to avoid preserved food. Get the option of low salt food. When you go to a hotel everybody asks for a low sugar coffee. Have you ever seen anybody asking for less salt in the food? I have never seen anybody asking for that. When you go out you are forced to eat with salt.

UK is the world leader in salt reduction campaign. United Kingdom showed that if you reduce the salt by 2 g you can prevent 35,000 strokes per year. There is a drastic reduction in strokes and heart attack by just reducing salt. One public measure with immense benefit. The biggest source of salt in the UK is preserved/frozen/ready to eat food. What UK did is a very smart thing. They told the manufacturers to reduce the salt a little without telling the people. If you ask an average person he would say that the bread has the same taste without being aware that the salt has been reduced by 2 g. They have done it slowly over the years, and they have brought down both strokes and heart attacks.

Japan- used to have a very high salt intake. Japanese people use to add salt in rice while cooking itself. This is a habit seen in south India also. Japanese people use to add salt in rice and they were taking very high salt indeed and they reduced it as a government program. There was a reduction of strokes by 80%.

Salt not only produces high blood pressure. It is a common belief that if I do not have high blood pressure, then why should I restrict salt. People have a wrong idea. My blood pressure is normal, why should I reduce salt? I can eat normal salt. No salt has other harmful effects. So it can produce cancer of the stomach. Japan had the highest cancer of the stomach in the world. Strokes, I have already told you. Heart failure – even without the blood pressure going up the heart can pump less: kidney disease, kidney stones. If you take more salt, what it does is it drags the calcium with it and forms kidney stones. Same thing, the bones become weak, what is called osteoporosis. So if you take more salt, your bones become weak. Even wheezing, asthma is worsened by high salt intake. High salt intake has other complications.

So who is responsible? How do you reduce salt? So it is very difficult. It is a national problem, it is an international problem. How do we reduce it? People should be made aware that salt is not an essential nutrient, but it is a preservative. Which is worse, sugar or salt? You keep sugar, you keep salt, see where the ant goes. The ant goes to the sugar not to the salt. It knows if it goes to salt it will die and if a salt can kill bacteria in preserved food, it can kill you. So you should be educated first. Then, the government. The government requires to have certain policies regarding recommendation for salt intake. The most important player is the food industry. The government should make it mandatory that there should be a label in all the food that you eat and this label is a simple label.

This is called the signal labeling where there is a red, yellow and green. You do not have to know the numbers. You just go to the noodle shop, I mean you are buying a packed food, noodle, there are three signals in it. Red, green and yellow. You choose what you want. So you can choose your poison. That is different. But you should be educated, and you should be given the chance not to eat salt.

There are 64 countries which are taking action for reducing the salt intake in population. In some, it is a law and in others it is voluntary. It is high time India also has a salt control program.


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