Co-Authored by Arun Chockalingam
Americans by and large consume too much salt, more than twice the one teaspoon they should each day. Is reducing salt important for good health? The answer is a resounding YES!
While most people inherently know that reducing salt is good for you, confusion on this topic has probably arisen from interpretations of a recent Cochrane Review. An important contribution to advancing science, the review analyzed seven studies (6,489 patients) to see if advice to reduce dietary salt had any direct impact on cardiovascular disease and death. The reviewers concluded that there was not enough information to understand the direct effect of the advice to cut down on salt intake on cardiovascular disease. In fact, the Cochrane Review press release mentions that they would need to have data from at least 18,000 individuals for more definitive results.
Let us dispel any confusion there may be. There is a direct correlation between salt and hypertension -- and hypertension leads to cardiovascular disease.
Overwhelming Scientific Evidence
1. Increased salt intake may lead to hypertension and reducing salt can lower blood pressure in many people. A large number of studies show that salt intake is the major factor increasing population blood pressure. The World Action on Salt and Health, WASH, believes that the evidence linking salt to blood pressure is as strong as that linking cigarette smoking to cancer and heart disease.
2. There is a direct link between hypertension and cardiovascular disease. In fact, raised blood pressure is the most important factor involved in the development of cardiovascular disease, and accounts for 60 percent of all strokes and 50 percent of all heart disease (WASH). According to the World Hypertension League, reducing blood pressure can lead to a 35-40 percent reduction in stroke and a 20-25 percent reduction in heart disease.
The health benefits of salt reduction should really not be debated. Instead, we should be asking: What are the best ways to reduce salt intake?
Beyond Table Salt
Many people think that not adding table salt to prepared food is the best way to reduce salt intake. Many people may not know that salt added at the table and to food cooked at home accounts for just 5-10 percent of the salt consumed every day. According to the FDA, about 75 percent of our total salt intake comes from salt added to processed foods by manufacturers and to cooked food in restaurants, cafeterias etc. Salt is added as a preservative to many foods, so we often consume salt without even knowing. Reduction of salt in packaged and restaurant foods is the most important way to reduce dietary salt.
Taking Bold Action
The UK has been a pioneer in salt reduction and has been successful in working with the food industry to gradually reduce salt in packaged foods so that it is not discernible to the public. Many countries have followed in the UK's footsteps and are making great strides in salt reduction.
We have already seen important developments in the U.S. In a 2010 report, the Institute of Medicine called for national action to phase down salt, asking the U.S. government to set standards and food manufacturers and restaurants to gradually reduce the amount of salt they use. New York City mayor Michael Bloomberg and health officials have pushed for a nationwide plan to reduce the amount of salt in packaged and restaurant foods by 25 percent over the next five years, and Walmart's voluntary pledge to reduce salt and sugar in the foods it sells is also noteworthy. The U.S. government's formation of an Interagency Working Group (between FTC, FDA, CDC and USDA), which developed a set of guidelines to improve the nutritional content of foods marketed directly to children, is perhaps the most promising step we have seen yet.
Increase Our Salt IQ
It is widely recognized that government action with the cooperation of the food and beverage industry is the best way to reduce salt. But commitments are not enough: we want to see action and results. However, there is also something we as individuals can do. We must each learn to read food labels more clearly and to reach for fresh foods and produce more often. We must learn that baked goods, soy sauce, frozen dinners and even some antacids can be high in salt. We must learn that a lunch of canned soup may contain a higher salt content than a hamburger and fries.
A "Best Buy" for Fighting NCDs
A recent Lancet article calls for a reduction in salt consumption as one of the top priority actions for the non-communicable disease (NCD) crisis. They say that reduction of population-wide salt consumption by only 15 percent -- through mass-media campaigns and reformulation of food products by the food industry -- would avert up to 8.5 million deaths in 23 high-burden countries over 10 years.
In fact, the WHO calls salt reduction one of the "Best Buys" in tackling NCDs because of its feasibility and cost-effectiveness. The two most important actions to combat NCDs -- full implementation of tobacco control and salt reduction -- are affordable in all countries and are estimated to cost about 20 U.S. cents per person per year in China and India.
1.5 billion people in the world today have hypertension. Hypertension leads to cardiovascular disease. Cardiovascular disease is the number one killer globally. Reducing salt is a simple prevention tool that I believe we must implement effectively.
Dr. Arun Chockalingam is the Secretary-General of the World Hypertension League. Nalini Saligram, Ph.D., is the Founder and CEO of Arogya World.
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