Sunita finds it impossible to do things a five-year-old can. Her gait is slow, and she can’t carry out even the smallest household chores. The 30-year-old depends on others for support, which makes her slip into depression.
A dialysis catheter juts out of a vein on the right side of her neck, advancing downwards into her chest to continuously clean her blood. For a lifetime. Sunita finds it hard to lift even 100 gm. The Delhi-based woman needs dialysis in a hospital thrice a week. Her extremely high blood pressure due to excess salt led her to this precipice between life and a slow death.
Sunita was not always like this. Her love for salty food made her slip into the maddening vortex of renal failure four years ago when she was just 26.
“Had Sunita not overlooked the warnings given by doctors over the years for not having an excess intake of salt, she would have been a normal person,” says Dr Sanjiv Jasuja, Senior Nephrologist at Indraprastha Apollo Hospitals, Delhi, who is treating her.
Sunita is not alone. A recent study by George Institute for Global Health (GIGH) revealed some worrisome facts about this insidious enemy we use every day. It indicates that as against the World Health Organisation’s (WHO) recommendation of 5 gm consumption of salt per day for a healthy adult, Indians consume over 10.98 gm each day—119 percent more than the recommended limit.The study analysed the salt intake of 227,214 Indians, aged 19 years and older.
WHO believes that high salt consumption contributes to high blood pressure and increases the risk of cardiovascular diseases (CVDs), kidney failure, brain stroke, obesity, thyroid and many more serious ailments.
A high salt intake causes water retention in our body, which leads to hypertension. Salt absorbs moisture because it is an ionic compound with strong attractive forces for highly polar water molecules. Sodium, a major ingredient of salt, attracts water like a sponge and increases fluid in the body.
More than 70 percent of the human body consists of water. Blood is also mostly water. When the water level increases in the blood, the force of blood flow through vessels consistently remains high and becomes dangerous. Blood pressure rises and falls throughout the day, but can cause health problems if it stays high for a long time.
Normal blood pressure levels are 120/80. The first number represents the highest blood pressure (systolic pressure) in the arteries, while the second represents the minimum amount of blood pressure (diastolic pressure).
According to Indian Council of Medical Research, the country has a prevalence of 25-30 per cent hypertension cases. A study indicates high blood pressure is a leading cause of CVDs, which accounted for 23 per cent of all deaths in India between 2010 and 2013. Says Dr J P Saini, chairman, Cardiology Department of Sir Ganga Ram Hospital in Delhi, “High blood pressure causes deposition of cholesterol in the walls of blood vessels. This makes them thick and narrow, and they can’t carry enough blood to the heart, which leads to heart failure. The thickened blood vessel walls can also lead to clots, which block the blood supply to the heart and cause a heart attack.”
It’s alarming that cardiovascular problems are spreading among the very young. “Of 100 patients, five are in the age group of 15 to 30 years,” says Dr Saini. Preference of fast food and aerated drinks high on salt content make the younger generation prone to heart problems.
“If we control blood pressure, the risk of heart diseases fall by 30 per cent,” says Dr Mukesh Goel, senior cardiologist at Indraprastha Apollo Hospitals, Delhi. “About 15-20 years ago, if a patient in his 20s came with chest pain, anxiety and sweating, we never diagnosed a heart problem. It’s different now. If an 18-year-old complains of chest pain, we think he/she might be a heart patient. Earlier, the age for CVDs was 50-70. Now the common age group is 35-50.”
Dr Prabir Agarwal, cardiologist at Delhi-based Escorts Hospital, agrees. “It is alarming that an increasing number of young people are coming to cardiologists. There is an urgent need to educate people about ill-effects of excessive salt,” he says.Dr Prabhakaran, who is associated with Public Health Foundation of India, says in an article that CVDs are the leading cause of mortality in India. He suggests that a mere 1 gm reduction in salt consumption per day can reduce the disease burden of CVDs by up to 4.8 per cent.
Nephrology and neurology experts also raise alarm on rising cases of kidney failure and brain stroke due to high blood pressure. A study suggests that strokes are the cause of death in about 13 percent cases, similar to deaths due to coronary artery disease. A stroke usually occurs when the blood supply to a part of the brain is cut off, reducing the flow of oxygen to it, causing cells to die.
Each kidney is made up of about 10 million of filtering units called nephrons. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce one to two quarts of urine, composed of wastes and extra fluid. Due to increased blood pressure, the kidneys’ blood vessels get thicker and hamper filtration, leading to waste remaining in the body. This ultimately leads to kidney failure.
There are two main types of strokes—ischemic strokes, when a blood vessel is blocked; and haemorrhagic strokes, when a blood vessel bursts and bleeds into the brain. “High blood pressure is the most important risk factor for a stroke, and salt is the major factor that raises blood pressure,” says a senior neurologist at AIIMS, Delhi.
Salt doesn’t only attack kidneys and the heart. A high salt diet increases the risk of stomach cancer. A quarter of 7,000 new cancer cases each year can be attributed to salt. The bacterium Helicobacter pylori (H. pylori) is the major risk factor for stomach cancer, say experts. H. Pylori in the stomach doesn’t necessarily cause damage, but salt can damage the lining of the stomach, making it more vulnerable to the effects of H. pylori. Salt may also increase the growth and action of the bacterium, making it more likely to cause damage.
Osteoporosis is another problem related to excess intake of salt. “Osteoporosis is a condition that causes thinning of bones, making them brittle and prone to breaking. Most calcium in the body is stored in bones. A high-salt diet can cause calcium to be lost from bones and get excreted in urine, making bones weak and easily broken. High blood pressure caused by a high salt diet can speed up the loss of calcium from bones, worsening the problem,” says Dr Asha Sharma, a senior gynaecologist at Rockland Hospital, Delhi.
Postmenopausal women are more at risk of bone-thinning due to the drop in hormone oestrogen, which protects bone health. “The postmenopausal age of women has fallen drastically. Most women stop menstruating at the age of 35-45, compared to 50-55 years earlier. Due to this, more young women are getting prone to osteoporosis,” adds Dr Sharma.
“Excess of iodine (micro-nutrient in salt) causes hyperthyroid. Due to excess intake of salt, this problem has increased by 20 to 30 percent in the last 10 years,” says Dr S K Vanganoo, Senior Endocrinologist at Apollo Hospitals.
High blood pressure due to high salt intake increases the risk of stroke, and therefore the risk of dementia. The condition leads to a loss of brain functioning that affects memory, thinking, language, judgement and behaviour. A high salt diet can sometimes also aggravate symptoms of asthma. Salt also contributes to the risk of developing diabetes by raising blood pressure.
Consuming too much salt gives a bloated and uncomfortable feeling. Expert say this is also a sign when one needs to be alert as a constant bloated feeling could mean a person is consuming too much salt. Extreme thirst is another sign of extra salt consumption.
An alarming problem arising out of high salt intake is obesity. “Excess salt consumption leads to slowing down of metabolism. Hence, instead of converting into energy, fat starts depositing in the body, leading to obesity. And as salt increases thirst, you drink more sugary fluids, which induce weight gain because they are energy-giving drinks ,” says Sonia Rawat, Consultant and Director, Executive Checkup, Sir Ganga Ram Hospital.
There is danger hidden in what we eat. “Approximately 70 percent of the sodium in our diet comes from processed foods, including items that we don’t typically think of as salty, such as breads, cereals, butter, etc,” says Mukta Vashisth, Senior Dietician at Sir Ganga Ram Hospital. “We need to take small precautions to reduce salt consumption in our daily diet.”
Some ways to avoid extra salt is not to use table salt, not add salt to fresh fruits and salads or cooked food, reduce consumption of food high in salt such as namkeen, butter, bread, cheese and the deadly fast food. Restaurant food typically contains more salt than dishes prepared at home. Use herbs and spices instead of salt to add flavour in home-cooked meals. Include fruits and vegetables in your daily diet.
In rural areas, salted pickles, papad and other traditional food items account for relatively high consumption levels of salt.
Unfortunately, government policies fail to control quality and quantity of packed and other food items, leading to a rise in lifestyle-related diseases. Also, there is no strong mechanism to keep a vigil on the quantity of salt, sugar and fats used in processed and fast food, with the result that every food manufacturing unit has its own recipe.
A GIGH study surveyed 5,796 packaged food products of nine main food groups from eight branches of supermarket chains in Delhi and Hyderabad. They found huge differences in the salt content of similar foods, with some containing almost 10 times more salt than others.
India is still not up to the mark of other countries to tackle the menace of excess salt, sugar, fats, etc in food items. In some countries, the emphasis is given to salt that is low in sodium. There are strict guidelines about the quality and quantity of sugar and fats used in packed food, and the quantity of each ingredient used in packed food is printed on the packet.
After the Maggi controversy in 2015 in which it was found that the noodles contained 1,000 times of the permissible monosodium glutamate (MSG), Food Safety and Standards Authority of India took steps to mark food items that contain high salt, sugar and saturated fat as a junk food to curb lifestyle diseases.
Soumya Swaminathan, Director General of ICMR, says they have set up a scientific panel under the National Institute of Nutrition in Hyderabad to start a fresh study on salt consumption in India.
“We will try to persuade the government to make rules regarding fixed quantities of salt, sugar and fats in processed and fast foods once we have scientific figures on per day consumption of salt by Indians,” she says.Till then, salt will be a deadly powder in India, leaving people with life-taking diseases and even taking lives.