Salt does not damage health unless you have more than twice the recommended amount, said a new study in The Lancet, sparking outrage among public health experts who want salt intake cut in most countries by at least 30%.
The study, which analysed data from more than 95,700 people from 18 countries, including India, found that systolic (higher reading) blood pressure went up by 2·86 mmHg per 1 gm increase in sodium intake only in people who had more than 5 gm of sodium per day.
Five gm of sodium is equivalent to 12.5 gm of salt, which is 2.5 times more than the dietary salt intake of 5 gm (one level teaspoon of salt, 2 gm of sodium) per day recommended by the World Health Organization.
The Lancet study found that the harmful effects of sodium – high blood pressure, heart attack, stroke, congestive heart failure, cirrhosis (irreversible liver damage) and chronic kidney disease, among others – affected only communities in China, where the liberal use of soy sauce pushed sodium levels to more than 5 gm a day.
Similar findings by the same team of researchers published in The Lancet in 2016 were called flawed and rejected by many scientists and associations, including the American Heart Association.
The average salt intake in India is 10.98 gm a day, according to a systematic review of 21 studies and surveys done in India between 1986 and 2014 published in the Journal of Hypertension last year. How much salt people across India varies widely, ranging between 5.22 gm and 42.3 gm per day, found the study, which concluded that there was no doubt that population salt consumption in the country far exceeded the WHO-recommended maximum of 5?gm per day.
Several studies have shown lowering salt in the diet protects health. According to a review of studies covering over 170,000 people published in The BMJ, eating less than 5 gm of salt a day reduces risk of stroke by 23% and heart disease by 17%. The World Heart Federation estimates that reducing salt intake to 5 gm a day would prevent 3 million deaths due to heart disease and 1.25 million from stroke worldwide each year.
People who eat packaged foods invariably end up eating unhealthy amounts of salt, which is added to processed and packaged foods to enhance taste, give texture and bind in water to add bulk to the product. In middle class homes, more than half of the dietary salt consumed comes from hidden sources such as processed foods, be it breads, processed meats (cold cuts and sausages), cheese, biscuits, cookies, cakes and packaged munches like chips, salties and savoury mixes.
Nutritional labels list the amount of sodium, not the higher salt content. To get the salt content in a packaged food, multiply the sodium value listed with 2.5. Foods labelled “low salt” must have less 120 mg of sodium per 100 gm.
In India, packaged food majors including ITC, HUL, Nestle India, Britannia, Marico, MTR, Patanjali, Halidram , Kellogg’s, Kraft Heinz India, Bikano, MTR, Weikfield, FieldFresh Foods and Baggry’s have committed to the Food Safety and Standards Authority of India to voluntarily cut salt, sugar and fat in products by 2020.
It’s a step in the right direction but most people need to cut down on added salt by at least 30% to lower health risks. Having too little salt along with prescription medicines such as diuretics, ACE inhibitors and angiotensin II-receptor blockers prescribed for high blood pressure, kidney damage and heart failure may trigger severe electrolyte imbalance.
Shunning packaged food and eating home-cooked meals is the simplest way to eat salt in recommended amounts.