By Dr. M.N. Ravi, Clinical Director and Senior Heart Specialist, Narayana Multispeciality Hospital, Mysuru

Some habits die hard but we need to shake the salt habit to live healthy. Knowledge that excess salt is unhealthy is at least 4,000 years old. World Salt Awareness Week is observed from Mar. 14 to Mar. 20 to draw attention to the ill-effects of excess salt consumption. While salt (Sodium Chloride) is essential for bodily functions, high intake is harmful.

Daily allowance:  The amount of salt needed to maintain homeostasis in adults is less than a tablespoon (about 2 to 3 g per day) while the average Indian consumes 10 to 11 g per day.

Ill-effects of high salt intake:  Cardiovascular Diseases (CVD) are the leading cause of death in India, with hypertension responsible for 25% of 2.3 million CVD related deaths per year. India has committed to reduce salt intake by 30% by 2025 which is a global target to reduce the burden of non-communicable diseases.

Mathematical modelling suggests that at the present rate of salt consumption in the 40 to 69 years age group Indians, there could be 8. 3 million heart attacks, 8.3 lakh strokes and 2 million deaths over the next few years

Heart:  High intake of salt causes functional impairment of blood vessels and arterial stiffness contributing to hypertension. While hypertension causes increased heart muscle mass, high dietary sodium independently increases left ventricular wall thickness too.

Heart failure in association with hypertension is the consequence of several harmful effects of dietary salt. While hypertension is a silent killer, it can manifest with headaches, palpitation, chest pain, fatigue or nose bleeds.

The diastolic (filling phase) dysfunction usually precedes systolic (contractile phase) dysfunction and is due to collagen deposition and fibrosis of the ventricle related to salt intake.

Weight gain associated with salt and water retention that accompanies heart failure increases cardiac work and compounds heart failure.

Salt also increases hormone induced platelet aggregation. All these effects on blood, blood vessels and heart increase the risk of strokes and heart attacks.

Strokes: Higher the salt intake, greater the incidence of stroke. Salt consumption is a risk factor for strokes and quite independent of hypertension and stroke mortality has a strong association with dietary sodium.

Bone density and kidney stones:  High level of salt intake contributes to a reduction in bone density and weak bones prone for fractures. Also causes protein loss through kidneys. Salt triggered changes in calcium metabolism and hypertension promote formation of kidney stones.

Stomach cancer:  Excess salt consumption causes gastritis and in combination with gastritis causing bacteria (H. pylori), it can progress to stomach cancer.

Is sea salt / natural salt any better?

All types of salt are sodium chloride. Table salt, sea salt, Kosher salt, Himalayan pink salt, salt granules have a negligible difference in nutrition and hence produce equal harm.

Salt reduction strategies:   To develop effective salt reduction strategies, it is important to understand the specificities in salt consumption. In the Indian context, mean salt intake is similar in rural and urban population. While in the West 75% of dietary salt comes from processed foods, in India it is from home-made foods (added salt during cooking and on table) but with changing times and trends India may be seeing increased salt intake from pre-processed and packaged foods.

Indian consumers are moving away from traditional staple items towards a ‘Westernised’ diet including increased consumption of deep fried items, bread, bakery products and snack foods. Globalisation has also provided people with ready to eat food with added preservatives, meat or otherwise. This is compounded with a decline in consumption of coarse grains, fruits, vegetables and other fibre rich foods.

Tips for salt restriction: At supermarket  look for fresh fruits and vegetables, choose labels with low or no salt added and buy fresh, lean meat and fish.

If buying prepared meal, look for labels with less than 600 mg of sodium. Avoid bakery items, salty street side food, savoury snacks, chips, cheese, salted crackers etc.

At home:  Use salt substitutes / alternatives like spices, garlic and citrus juice.

Initiate healthy eating, prepare rice, parathas, rotis, pastas from most basic forms; Avoid papad, pickles, chutney powders (salted) etc; Consume more fresh fruits and vegetables; Limit sauces, mixes, instant products.

While dining out:  Ask no salt to be added; Order vegetables with no added salt or fresh fruit as side item; Share meal, avoid gravies, and salad dressings. Limit frequency of eating out.

Choose a heart healthy diet:  Hypertension is a pandemic and an evolutionary curse.  Start early – hypertension can develop in childhood and developing a taste for salt early in life will make it difficult to cut back later. Childhood is an important time to focus on prevention of hypertension.

DASH (Dietary Approaches to Stop Hypertension) eating plan is a simple heart healthy diet that reduces  blood pressure. DASH diet is low in sodium, cholesterol and saturated and total fats and high in fruits and vegetables, fibre, potassium and low fat dairy products.

Government role:  Salt reduction food policy has been a feature of many countries and is a cost-effective public health strategy.  Creating consumer awareness alone is ineffective because food industry is a major stakeholder. Large portions of salt we eat are already prepared and packaged food over which consumer has no control. The Government nutrition policy has to be strong.