Salt is an integral part of our diet. But, consuming too much or too little of it could adversely impact our health; hence, moderation is the key, says Geeta Padmanabhan

Salt is responsible for 2.3 million deaths globally, says a study released by Harvard School of Public Health. One in ten dies from a heart attack, stroke or some cardiovascular disease as a result of eating too much sodium, according to the study.

Salt is a hard habit to shake off. It is a basic taste, and if there are people with a sweet tooth, then there are some who crave salt. When we sweat or vomit, our sodium levels decrease and we get a salt appetite. Research suggests stress can make us reach for the salt shaker, leading to a salt-habit. We consume salt indirectly through processed/canned items where it is a preservative.

Is salt a villain? The sodium and chlorine in common salt are essential to maintain the fluid balance in our body and for normal cellular functions, says Dr. Priya Chockalingam, cardiac wellness physician. Also called electrolytes, they carry an electric charge and move in and out of our cells to provide energy for muscle/nerve/brain/heart cells to work. The normal sodium level in our body is 135-145 millimoles per litre of blood; too much (hypernatremia) or too little (hyponatremia) of it can cause cells to malfunction and extremes can even be lethal.

Less and more

Both increased and decreased intake of common salt can affect us, warns Dr. Y V C Reddy, Senior Consultant Cardiologist (Apollo Main). “Salt intake should be less in patients with hypertension and heart failure, where increased salt intake can cause fluid accumulation, increase blood volume and BP, and worsen breathing difficulty. In patients prone to hyponatremia, decreased salt intake can precipitate low-sodium problems.”

How much salt is too much? More than 4-6 grams/day is excess for a normal individual, he says. Patients with heart or kidney problems should reduce it to the minimum. No, we can’t avoid it completely. “Hyponatremia or low sodium in serum in certain patients can lead to seizures, brain damage, even death.” Aren’t some people unaffected by excess salt intake? “Our homeostatic mechanisms can keep blood-sodium levels optimal despite a lot of dietary salt intake,” he agrees, but “if you are a salt-sensitive, hypertensive person, excess salt is bad.”

Salt-BP nexus

Dr. Priya explains the salt-BP nexus. If the sodium level in the blood is more than normal, our body tries to neutralize that by increasing the water level in the blood (makes us thirsty to drink water, and kidneys restrict excretion), eventually bringing the sodium concentration to normal again. In this process, the circulating fluid level has increased, and this in turn increases the BP level. Apart from too much salt, being physically inactive, being overweight, excessive alcohol consumption and family history are risk factors.

What of potassium salt? Potassium salt can be used as a substitute in normal individuals, says Dr. Reddy. But for patients prone to hyperkalemia (too much potassium in the blood) this option is closed. Eating potassium-rich items such as bananas, tomatoes and low-fat dairy products has a heart-healthy effect, because it helps the kidneys remove excess sodium from our body, says Dr. Priya. So restrict the use of salt in cooking, have a lot of potassium-rich natural foods to keep BP under control.

Our love for processed items has left us getting much more sodium than required, says Dr. Priya. Our perception of taste has changed and we try to add more salt in our daily cooking. Fruits, vegetables, meat and seafood also contain sodium. Apart from the salt, processed items have baking powder, flavour enhancers and preservatives that contain a lot of sodium. “Salt is an integral part of our lives. But it is certainly a double-edged sword. We need strict balance since both too much and too less can be harmful.”

Some pointers on salt intake

WHO recommends limiting sodium to less than 2,000 mg/day.

American Heart Association recommends 1,500 mg/day. (One teaspoon of salt has 2,325 mg of sodium.)

Hence, keep intake of processed and tinned items to a minimum.

Avoid pickles.

Eat wholesome items like fruits, vegetables, lean meats and beans to satisfy your craving for salt.

Minimise the use of added salt in curd and salad. Remove the salt shaker from your dining table.