In India, salt (chemical name: sodium chloride, local name: 'नमक or namak') is not only an important ingredient on the kitchen shelf, it is also ingrained in our cultural psyche. There are many phrases in the vernacular Hindustani language which reflect its importance - जिसका नमक खाया है, उसके साथ गद्दारी नहीं कर सकते (you cannot be disloyal to someone whose salt you have eaten); if you are loyal to a person you are called namak halaal (loyal), else one is namak haraam (disloyal). Again, a sexually desirable person is often referred to as being नमकीन or salty.
I distinctly remember many elders of my and other families who would not partake of any salty food during social gatherings in other people’s houses, outside their clan, as it would morally bind them not to betray or go against that family. Many religious fasts prohibit the use of salt during the fasting period, as it symbolizes giving up something which you love the most, at the altar of God.
It is therefore no wonder that salt is such a revered commodity in India. Cultural sentiments apart, the Indian cuisine has always involved high usage of salt (and also sugar—as if one neutralized the other), partly in cooking and partly added at the table. It is still not uncommon in Indian households to keep a pinch of salt on the plate as an additional food item, along with the other eatables. Indian palates have always had a penchant for fried savoury snacks, pickles, chutneys, etc. If we add to this the ever increasing modern day consumption of salted potato chips, salted popcorns, instant soups, baked foods and other processed foods (pizza, burger), one can conclude that the Indians’ preference for all things salty seems to have increased, leading to a substantially excess consumption of salt.
Dr Anil Kapur, Managing Director of the World Diabetes Foundation, attributes this to the ‘increasing popularity of the eating out concept in urban India, as restaurant food is more likely to a have higher salt content. He also blames the hot climate which makes the people sweat a lot, leading to salt loss and this in turn may contribute to salt craving and higher salt consumption. Once a taste for higher salt is acquired it sticks for the rest of the life. The higher amount of carbohydrate in the diet also facilitates absorption of sodium. He feels that changes in dietary patterns, occupation and lifestyle are some of the possible contributors to the rapid rise in prevalence of hypertension in urban Indians.’
Well, it is high time we start limiting its use in our daily lives, not merely to appease the gods, but for the sake of our own physical and mental well being. Numerous studies have proved that excess dietary salt intake is a significant risk factor for hypertension and cardiovascular diseases.
According to Dr Anoop Misra, Director and Head Department of Diabetes and Metabolic Diseases, Fortis Hospital, New Delhi, “High salt intake indirectly increases the chances of increasing heart diseases, stroke and kidney failure as all these are caused by high blood pressure. It can also result in oedema or fluid retention in the body, because if there is too much salt, the kidneys cannot eliminate it fast enough. A study published in British Medical Journal shows that a low salt diet (5 g/day) reduced stroke by 23% and total cardiovascular disease by 17%, thus averting 1.25 million fatal and non-fatal strokes, and almost 3 million vascular events worldwide each year. Studies have also shown high salt intake causes cardiac enlargement, a strong risk factor for cardiovascular disease. Excessive salt intake, combined with an inadequate intake of water, can also aggravate renal disease.”
Dr Misra rues that salt consumption in developing countries is increasing with increasing urbanization, with the urban population of New Delhi indicating an average salt intake of 8.3g/day, which is considerably higher than dietary recommendations for Asian Indians (5g/d). Factors contributing to increase in salt intake include ‘richer’ foods associated with higher income levels and eating out, particularly the fast-food culture which invariably increases intake of salty and fatty foods.
A CURES study conducted in 2007, on the urban south Indian population, reported that the mean intake of dietary salt is 8.5 g/d, which is almost 70% higher than that recommended by the World Health Organization (<5g/d). Intake of salt was found to be significantly higher in those with higher household incomes, and also in the very young and old population (average salt intake in the age group of 20-29 years was 8.1g/d and 9.6g/d at ≥ 60 years).
This study also confirmed that subjects with higher salt intake showed significantly higher prevalence of hypertension. Addition of a mere 1 teaspoon salt per day at the dining table significantly increased the prevalence for hypertension compared to zero added salt (38.5% vs 23.3%). Thus statistically, total dietary salt intake was found to be positively associated with hypertension and this association was independent of age, sex, body mass index, total energy and dietary fat intake.
These documented evidences from Delhi (in the north) to Chennai (in the south) confirm the general predisposition of the Indian populace towards a salt rich diet which is playing havoc with their health. It should set the alarm bells ringing for taking urgent steps to decrease salt consumption and control the ever increasing prevalence rates of hypertension and premature coronary artery disease, especially in urban India.
Studies in western populations too have shown similar results-- that dietary salt intake is a significant risk factor for hypertension and cardiovascular disease. The findings of Dr. Klaus and colleagues confirm that ‘people, whose intake of dietary salt is in excess of 6 g per day, increase their risk of cardiovascular morbidities and hypertension. Salt restriction may not only help to prevent cardiovascular morbidities but may also counteract other lifestyle diseases such as obesity and diabetes.’
Another study jointly conducted by the University of California, San Francisco, Stanford University Medical Centre and Columbia University Medical Centre in 2010, proves that ‘A very modest decrease in the amount of salt, by as little as one-half teaspoon, which will be hardly detectable in the taste of food, can have dramatic health benefits and result in fewer heart attacks, strokes and deaths.’
Salt reduction is one of the low cost but effective interventions, proposed by The Lancet NCD Action Group and the NCD Alliance, to create a sustained global movement against premature death and preventable morbidity and disability from Non Communicable Diseases (NCDs). Consumption of foods high in saturated and industrially produced trans fats, salt, and sugar is the cause of at least 14 million deaths or 40% of all deaths every year from NCDs. Over consumption of salt alone causes up to 30% of all cases of hypertension. Reduction of population-wide salt consumption by only 15% would avert up to 8•5 million deaths in 23 high-burden countries over 10 years.
Therefore, public health strategies must be developed for educating people to avoid excessive use of salt in cooking/adding salt at the table, limit the consumption of food items which are high in salt, like processed and junk/fast food, increase the intake of low salt foods like fruits and vegetables, and traditional low salt, high fibre cuisines.
The food industry and those who regulate it could contribute substantially to the health of the nation by achieving even small reductions in the amount of salt in the processed food items, and also in those served in restaurants.
Such measures, if carried out across the whole population, could have substantial benefits in reducing the burden due to hypertension in India. A diet low in saturated and trans fats, salts and sugar, will prevent cardiovascular disease, obesity and hence diabetes.
Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She is also the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: firstname.lastname@example.org, website: http://www.citizen-news.org)
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