Diabetes is a chronic metabolic disease affecting many Indians and people all over the world. Those with diabetes are at a higher risk of developing health complications impacting the heart, nervous system, and kidneys. Problems like hypertension are twice as common in diabetics and this also increases the chances of cardiovascular diseases. A diabetic person with high salt intake has greater chances of developing hypertension. Although salt does not have an effect on the blood sugar process, excess salt has other implications in a diabetic.
The United Nations recently called for a global effort to reduce salt intake. There was a consensus on setting global health targets for the year 2030. One of these was to reduce the daily intake of salt to 5 g/day. A Cochrane review, which forms the basis of this agreement, clearly mentions the health benefits of reducing sodium intake. Hypertension and cardiovascular diseases are both offshoots of diabetes. It is possible to reduce the occurrence of these diseases with the help of a low-salt diet. The Yanomoto Indians of Brazil are one of the few ‘salt-free’ communities alive. This is because their diet is composed of only that salt which is present in the meat and vegetables they consume; nothing extra. They, thus, have lower blood pressure levels than other ethnic tribes and communities.
The case of India
Indian cuisine, besides being rich and diverse in taste, is also high on salt. The ‘salt to taste’ phrase becomes a misnomer in the Indian context with its usage being ubiquitous in curries, salads, and other dishes, and reaching extremely high levels in foods like pickles. It is not easy to measure the intake of salt given the vast range and heterogeneity of an Indian kitchen. A survey by the ICMR (Indian Council of Medical Research) found that the daily salt intake in 13 states was about 13.8 g. The National Institute of Nutrition (NIN) at the time of this survey (1986-1988), had set a limit of 10g/day!
In India, it is difficult to measure the salt intake since drinking water also contains sodium chloride. In certain parts of the country, for example Rajasthan, the ground water can have higher salt content. Certain water softeners also use large quantities of salt to purify water, which is absolutely unnecessary, not to mention, harmful.
A diet containing excess sodium can cause a rise in blood pressure. About 40% sodium is found in common table salt. Sodium is used by our body in small amounts to maintain fluid balance. It is extremely crucial for diabetics to consume a diet low in salt because diabetic hypertensive patients can develop coronary artery disease or an enlarged heart.
Where is the salt hidden?
Packaged and prepared foods are high on salt content. This is because salt is used as a preservative and makes food taste good. The food in restaurants is also notorious for the amount of salt used. There are some food items which have high sodium content. It is always good to read the nutrition facts mentioned on the label to gauge the amount of salt in it. Some foods high in sodium are listed below:
One way to counter salt intake and lower the sodium in your diet is to reduce eating out. Eat freshly prepared, home cooked, unprocessed food. 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 flavour of food.
You can try and make the following as the base of your daily diet, instead of relying on processed food:
The way forward
There is a need for a sustained and concerted effort to make the public aware of the ill effects of excessive salt intake. A public awareness programme that focuses on reducing the consumption of papads, pakoras, and pickles (the three Ps) is the need of the hour. It should also encourage the use of sodium-free substitutes. So far, however, there seems to be no concerted effort at health advocacy in this field in India. There can be a gradual and phased out effort to reduce sodium content in all processed and branded food products by the food industry. Food labels should display the sodium content, while mentioning the daily recommended allowance. As for other food groups, standardised serving sizes should be popularised for salt (1 tea spoon = 5 g salt = 2 g sodium) as well.
Mahatma Gandhi led the Dandi march or the salt movement in 1930 in an effort to highlight the right to manufacture salt as a symbol of independence for the Indians in that era. There is a need to revisit that movement today, but in a different direction. A Dandi march, if undertaken today, will be to highlight the right approach to remain healthy in an environment of excess salt intake prevailing amongst the current generation of Indians.
Dr Sanjay Kalra, Consultant Endocrinologist, Bharti Hospital Karnal& Vice President, South Asian Federation of Endocrine Societies