After sugar, it is time to regulate how much salt is being consumed
Salt reduction in diet is the most cost-effective measure to control non-communicable diseases. The World Health Organization had previously cautioned that the world is off track to achieve its global target of reducing salt intake by 30% by 2025
After the COVID-19 pandemic, what seems to have caught the world’s attention is salt intake and its harmful effects on the human body. Recently, the Indian Council for Medical Research tweeted about the ways to reduce salt intake by avoiding the addition of salt while cooking rice or preparing the dough, skipping pickles and table salt and going in for salt substitutes. It rightly pointed out that children, younger than 12 years, require only three grams of salt per day.
The World Health Organization had cautioned a couple of months ago that the world is off track to achieve its global target of reducing salt intake by 30% by 2025. The report shows that only 5% of the WHO member states have mandatory and comprehensive sodium-reducing policies. Additionally, seventy-three per cent of the WHO member states lack the full range implementation of the policies.
Implementing highly cost effective sodium reducing policies could save an estimated seven million lives globally by 2030.
Reducing sodium in diet
An unhealthy diet is the leading cause of non-communicable disease, with excess sodium being the main culprit. WHO has suggested the following measures — reformulation of food to contain less salt; controlled procurement of high sodium food in public institutions like schools, workplaces and hospitals; labelled promotion of packed foods with low sodium choices and achieving behavioural changes in population through campaigning in media.
The WHO has also established a scorecard for various countries. According to that card, India does not have a national policy but it does have voluntary measures to reduce sodium. However, this has not caught up well in the last decade. Only persons who have hypertension or kidney disease are advised by their personal physicians to reduce salt in the diet. The population at large is still not aware of the danger of hidden salt — salt that is present in ready-made and packed foods.
The effects of excess salt
Unfortunately, sodium labelling is not mandatory in our country so far. It is also important to use the word salt rather than sodium so that people can appreciate the relationship to hypertension. A recent study from Sweden has shown a connection between salt consumption and atherosclerosis, even in the absence of hypertension. Atherosclerosis is a disease which blocks the blood vessels. The study included 10,788 individuals between 50 to 64 years. Every gram of extra sodium was associated with a 9% occurrence of plaques in the carotid arteries which supplies blood to the brain; and a 17% increase in coronary artery plaques.
Recently, a salt awareness week was celebrated between May 15 to May 21. The pioneering organisation from U.K., WASH (World Action on Salt and Health) has been spearheading campaigns all over the world.
Sapiens Health Foundation, an NGO from Chennai has also been campaigning throughout India since 2010. The organisation was given the Notable Achievement Award by the World Hypertension League in 2014 for reducing salt intake in the population. So far the studies conducted in India have been in small numbers of approximately 1,000 individuals. The foundation is planning to form a low-salt group and involve more than 100 physicians and food manufacturers to conduct research and bring down the sodium content of packed foods. The foundation has already written to more than 300 food manufacturers in the country to use modern technology for prolonging the shelf life rather than use sodium and that low-salt substitutes should be offered in various snacks. It has also written to the Central Government to make salt labelling mandatory and copy the signal labelling of U.K., where a red colour indicates unhealthy high salt content.
To reduce salt consumption
The U.K. has been the leading country in the world to have reduced salt consumption in the population. Over the last decade, the salt content of bread has been brought down by 30% gradually, without people being aware. This has resulted in preventing thousands of strokes and cardiovascular events. According to a Cochrane review, reducing salt in the diet in diabetic patients is associated with slower progression of kidney disease, with fewer drugs required to control blood pressure.
During the COVID-19 pandemic, there were notable studies from China and Germany which pointed out the association between high salt intake and decreased immunity in the body. Salt reduction in the diet is the most cost-effective measure to control non-communicable diseases. India should wake up to this reality. Improving the quality of life by avoiding strokes and heart attacks is the goal — not just prolonging longevity.
The writer is a senior nephrologist based in Chennai, and chairman, Sapiens Health Foundation