|Year : 2013 | Volume
| Issue : 1 | Page : 1-2
Reducing salt intake, for a healthier world
Sanjay Kalra1, Manisha Sahay2, Manash P Baruah3
1 Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
2 Department of Nephrology, Osmania Medical College, Hyderabad, India
3 Department of Endocrinology, Excel Hospitals, Guwahati, India
|Date of Web Publication||1-Jan-2013|
Bharti Hospital and BRIDE, Karnal, Haryana,
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kalra S, Sahay M, Baruah MP. Reducing salt intake, for a healthier world. J Med Nutr Nutraceut 2013;2:1-2
Foods which are bitter, sour, salty, over hot, pungent, dry and burning, and which cause suffering, grief and sickness, are dear to the Rajasika.
- Bhagavad Gita 17:9
Recently, the United Nations has called for a global effort to reduce salt intake. Agreement has been achieved to set various global health targets for 2030, including a reduction in daily salt intake to 5 g/day. 
The United Nations call is backed by a Cochrane review, which clearly points out the perils of the health benefits of reducing sodium intake.  A low-salt diet reduces the incidence of hypertension and other cardiovascular disease. Thus, reducing dietary salt intake to 3 g/day, i.e., 1.2 g of sodium/day, can positively impact public health.  This simple, (and free-of-cost) measure will help reduce morbidity and mortality related to hypertension and cardio-vascular disease, including stroke, coronary artery disease, and peripheral vascular disease. This in turn will lead to huge savings in medical costs.
The physiologic and biochemical basis of these findings is not difficult to fathom. What is relevant for India, and for many other developing countries, however, is that Blacks and Hispanics tend to have a greater beneficial response to a low-salt diet than Caucasians. 
There is a small body of literature, highlighted by the website of the Salt Institute,  which warns against the dangers of a low-salt diet. It is difficult; however, to reconcile the messages contained in these publications with those of the vast collection of epidemiological, preclinical and clinical studies, which advise lowering of sodium content.
What the United Nations and the Cochrane review tell us has been known to the Yanomoto Indians of Brazil for centuries. One of the few "salt-free" communities on earth, their diet does not contain extra salt, apart from what is present in the meat and vegetables they consume. This indigenous Indian group enjoys lower levels of blood pressure than other ethnic groups, which consume salt. 
In India, unfortunately, salt intake is on the higher side.  Measuring salt intake in India is not easy, given the vast range and heterogeneity of the Indian kitchen. An Indian Council of Medical Research survey reported a daily salt intake of 13.8 g in 13 states, which was greater than the 10 g/day limit set by the National Institute of Nutrition (NIN) at that time (1986-1988).  The Chennai Urban Rural Epidemiology Study reported a mean dietary salt intake of 8.5 g/day in 2007, with greater consumption in richer and elder persons. A significantly high prevalence of hypertension was noted in high salt consumer. 
Difficulty in measuring salt intake is compounded by the fact that drinking water also contains sodium chloride. While the content of sodium chloride is minimal (20 mg/L) in most water supplies, ground water in certain areas of the country (for e.g., some parts of Rajasthan), may have higher salt content.  The same holds true for drinking water purified by certain water softeners.
Indian cuisine is rich in diversity of taste, but unfortunately in salt content as well. Salt is ubiquitous in our curries, salads and biryanis, reaching extremely high levels in papads and pickles. While the high salt content is deplorable in itself, it is unnecessary as well: Indian cuisine is rich in non-sodium containing spices, such as asafoetida (heeng) and cumin (zeera), which can be used as salt substitutes, to enhance the flavor of food.
A sustained and concerted effort should be made to raise public awareness regarding the harmful effects of excessive salt intake. Perhaps health care professionals need to understand, and follow recommendations for optimal salt intake before counseling others. The lead should be taken by endocrinologists and nephrologists, who observe sodium-related morbidity in a significant proportion of their patients.
A public awareness program, focusing on reducing consumption of the three Ps: Papads, pakoras and pickles, while encouraging use of sodium-free substitutes, should be started. One can begin work on this through hospital-based or clinic-based education, and gradually roll it throughout the country. In-spite of the simplicity, easy, and utility of this intervention, there seems to be no concerned effort at health advocacy in this field in India. Perhaps hypertension is a Cinderella disease, treated by all medical specialties, but owned by none.
The food industry should be called upon to reduce sodium content in all processed and branded food products, in a gradual, phased manner. Food labels should display sodium content, and mention the daily recommended allowance as well. Standardized serving sizes should be popularized for salt (1 tea spoon = 5 g salt = 2 g sodium), as has been done for other food groups.
Similar actions have already been taken by concerned national bodies. In India, for example, the NIN reduced the recommended daily salt intake from 10 g to 5 g in 2010.  In the United Kingdom, a 10% reduction in salt content of processed food over the past decade has saved 6,000 premature deaths per annum, as well as 1.5 billion in health costs.  On the other hand, a 'policy paralysis' has prevented many other countries from pursuing such public health interventions.
In 1930, Mahatma Gandhi began the salt movement or Dandi March, highlighting the right to salt manufacture as a symbol of independence for that generation of Indians. A similar movement is required today, albeit in a different direction, highlighting the right approach to remain healthy in an environment of excess salt intake prevailing amongst the current generation of Indians.
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