Addiction to salt

Published in State Dailies

The recent ‘Salty rumours’ has little relation with this article. But while salt is still in our mind, let me put forward this pressing health concern. Salt is addictive. Research shows that salt addiction is like addiction to hard drugs or cigarette. The easy availability of salted processed food from the market results in increased intake of salt. The human tongue can be trained that it gets accustomed to food with high salt content. It is not only for preservation; salt produces a craving and helps in sales of such food products. 

 

In Nagaland, salt intake is mainly from the added salt while cooking. The use of processed ‘junk’ food is on the increasing trend. So, we now have the dual problem of high dietary intake of salt in the normal meals and increased intake of salted processed/packaged food. Salt intake varies between individuals, families, and tribes. The amount of salt intake is determined not by biological need but by culture and individual behaviour.

Daily salt intake is increasing all over the world. In most countries, an average person consumes about 8-12 grams every day. The WHO daily recommended salt in diet is 5 grams (equivalent to 2 grams of Sodium). An average American consumes about 9 grams daily (which is about 2 teaspoonfuls). Majority of this comes from processed and restaurant foods.  In India, according to a multi-centric study in 1996, daily intake ranges from 7 to 26 grams. The study says that the most salt-sensitive population is in the North Eastern part of India. In contrast to the western countries, most of the salt is added while cooking and/or at the table, in our part of the world.

High salt intake leads to high blood pressure. High blood pressure (Hypertension) leads to a number of heart, kidney, and brain problems. About 25 health problems are listed which are related to excess salt intake. WHO says that the best evidence of a dietary factor causing cardiovascular disease is the connection between high salt intake and Hypertension.  In the South East Asian Region, one in every three adult is hypertensive and it kills 1.5 million people annually. Sodium in salt retains fluid and makes the heart work harder leading to cardiovascular diseases. Cardiovascular diseases are the leading cause of death worldwide. They are difficult to treat. Management takes time and are expensive. Therefore in resource poor setting like ours, prevention through reduce in dietary intake of salt is a cost-effective option. 

What are the practical ways to reduce salt in the diet? You can start the day by watching what you have for breakfast. Look for sodium content in the food products you eat and select the ones which have low sodium content (not more than 120mg/100gm). Opt for unsalted food products or prepare your own unsalted-breakfast. Strike out from your shopping list processed foods which have high salt content. Buy more vegetables and fruits. If you want to add flavour while cooking, choose alternatives to salt like vinegar, spices, or local herbs. This is important in our context because traditionally we cook meat with a lot of salt as flavour. We can try to retrain the tongue to appreciate meat with less salt, however hard that may be. Or there can be a compensation somewhere where we cut down on salt intake. If I eat meat, I can avoid eating potato chips that day. 

In Mexico City, authorities have removed salt shakers from the restaurant tables. We can remove them from our dining tables. If you are visiting a family with kids, you can buy them stuffs other than coke and potato chips. Families can decide to cut down on salt in their curries, chutneys, salads; and revise their shopping list. There are multiple ways to reduce salt intake.

What about the risk of too less salt in diet? Such situation will hardly arise in a normal setting because we have multiple sources of food from where we get the daily sodium requirement. And common salt is not the only source of dietary sodium. Foods containing sodium are egg, carrot, garlic, broccoli, etc. What about the danger of Iodine deficiency when we don’t take sufficient iodised salt? Iodine is a micronutrient required in micro-amount. There are other sources of Iodine like milk, cod, shrimp, boiled egg, green beans, banana, etc. To prevent the loss of Iodine in iodised salt, it is advised that salt be put towards the later part of cooking. What we can do when trying to put less salt and retain iodine is in adjusting this timing of putting salt. There is also a way to neutralize excess sodium in the body. It is through increase in Potassium intake. Potassium rich food are beans, dark leafy greens, potatoes (with skin), dried fruits, mushrooms, bananas, etc. 

We find a lot of hypertensive patients in our villages. It is not because of sedentary lifestyle or processed food (although the village lifestyle and food habit are fast changing). It is because of salt in our meals (there are other reasons too). So, diseases which were considered as diseases of the urban rich are also being seen in the villages. Our urban population is already facing the heat of the problem. Price of organic food is skyrocketing. Processed foods are cheap and easy to prepare. Lifestyle and dietary habits are changing with urbanization, modernization, globalization, westernization. Pattern of diseases is changing. We are on the brink of (or, it is already) an epidemic. Unlike the outbreak/epidemic of communicable diseases like malaria or typhoid, these salt related non-communicable diseases happen very slowly. We call them ‘Silent Epidemic’. 

 Spread the awareness. This is not a rumour.