The Impracticality of Salt Control
Day to day control of salt intake is impractical, but there are practical ways to reduce excess salt consumption
Bhavin Jankharia
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A recent Indian study [1] concluded that Indians ingest a lot of extra salt in their food. The authors seem to believe that the amount of salt they found Indians consuming is high and responsible for an increased incidence of cardiovascular disease and mortality and that by reducing the salt intake by 1.2 gm/day, we will be able to reduce our incidence of cardiovascular disease.
I wish things were so simple.
The study is interesting because the sodium estimation was made on spot urine samples, rather than just a physical questionnaire. Men had an average intake of 8.9 g/day or salt and 7.1 g/day for women, which works out to between 1-2 teaspoons a day or between 4.0 gm of sodium/day for men and 3.2 gm of sodium/day for women.
While the WHO and most guidelines recommend that the salt intake should be less than 5 gm/day and the sodium intake less than 2.3 gm/day, there is no high-quality data for these specific cut-offs. There is a also a likely U-shaped curve that suggests that even up to 4.6 gm/day of sodium or up to 10 gm/salt per day is fine, which works out to 1-2 teaspoons a day.
These dissenting voices [2] say that since sodium is an essential electrolyte, too low a sodium intake can create problems just as too much of sodium. Reducing sodium intake works best in those who already have high blood pressure, but does not often make much difference to healthspan and lifespan in those who do not have high blood pressure.
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These Indian numbers actually then help us set a baseline. If we assume that these numbers obtained from 3000 people across the country from all walks of life are representative of what is currently normal, then these are the normal benchmarks that we should use to see if our sodium and salt intake is high or not. Practically, anything more than 2 teaspoons a day should be considered high.
However, it is quite impossible to monitor salt and sodium intake on a daily basis. You can control what you put inside your cooked food, if you cook it yourself, but it is tough to figure out how much salt others are using, and if you eat out, cooks in restaurants always tend to overdo the amount of salt in their foods. If you eat processed and ultra-processed foods (UPFs), they will almost always contain large amounts of salt.
The only way really to control salt intake is the following
1. Reduce the consumption of UPFs.
2. Do not add extra salt to food.
3. Use a potassium enriched salt substitute (PESS).
These efforts should likely help us reduce our salt intake to between 5 and 10 gm/day and our sodium intake to between 2.3 and 4.6 gm/day.
What does this mean for you and I?
Unless you have a specific clinical disease like heart failure or severe high blood pressure, then monitoring salt intake in today’s day and age is impractical. However, by reducing our intake of UPFs and by not adding extra salt to foods, and switching to PESSs we can keep some control over any extra salt consumption. Diagnosing high blood pressure and treating it is far more important than focusing on salt intake for primary prevention of high blood pressure.
Footnotes
1. Mathur P et al. Awareness, behavior, and determinants of dietary salt intake in adults: results from the National NCD Monitoring Survey, India. Sci Rep. 2023 Sep 23;13(1):15890.
2. Rosengren A. Salt: the sweet spot? Eur Heart J. 2022 Aug 7;43(30):2889-2891.
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