Salt in hypertension

“Some seek not gold, but their lives not a man who does not need salt”, Roman statesman Cassiodorus once said. In the olden times, Salt was a heavily taxed and valued commodity- comparable to gold itself. Salt was traded extensively and many wars have been fought over it. Some ancient civilizations have minted salt into coins and used it as a basic currency!!

What Proverb is to a Speech- Salt is to Food!!

Salt is the most important aspect in food- all foods, all over the world have one thing common I them- salt. Yes, salt is what makes all the difference in the food that we eat. The salt intake in the past 20 years has gone up drastically, and thus we face the dilemma of – Should we eat salt or not? Should we change the type of salt that we eat?

Mr. Deshpande, a hypertensive, asked me one day “how much salt can I have in my food daily?” He had been trying to regulate his dietary habits for a long time to control his high blood pressure levels and maintain a healthy weight. I smiled, after almost 3 months, he finally asked me this question. I thought of telling him that the guidelines say that we need to have 6 gms of salt per day. Then, I stopped myself. He had a right to know that it’s not salt per se that is the culprit- we have to understand that there is a difference between salt and sodium. And here, we are talking about sodium. And so I started, “Mr.Deshpande, You have asked me an extremely important question. But let’s begin at the beginning. Salt is composed of Sodium and Chloride of which Sodium is 40% and Chloride 60%.

Sodium plays an important role in retaining water in the body and thus can result in fluctuations of blood pressure or increase the oedema as it is increases the total blood volume in the body. But this is only one aspect of what sodium does. It also works in the body in following ways-

  1. It stimulates the nerves and helps in nerve conduction, thus acting as a messenger between brain and the muscles.
  2. Salt is one of the components responsible for activating various digestive enzymes which help in breaking down food. Also, the Chloride from the salt helps in production of hydrochloric acid, which is released in the stomach for digestion of proteins.
  3. Lastly, but most important, it regulates the blood volume. Salt has a property of absorbing and holding water, which results in increasing the total volume of blood in the body, thus can result in increase in blood pressure. Yet, salt is an integral part of the diet and until and unless medically advised, should not be eliminated completely from it.

Coming back to the question- How much salt should be consumed every day?

1 tsp of salt eaten every day for healthy individuals is a standard recommendation or 2300mg of sodium per day. In case of high blood pressure, it should be reduced, but not totally eliminated until and unless specifically asked by the dietitian or the doctor. Some medicines used to reduce high blood pressure have an effect on how the kidneys work and may result in loss of sodium through urine, in such cases, salt should not be reduced, I explained to Mr. Deshpande.

Usually, salt restriction is also advised in certain kidney and liver diseases. At times, simple cases of oedema are also relieved by reducing the salt. So, I Said, “Mr. Deshpande, it’s not only in Hypertension that salt plays a role. There is totality we have to look at before increasing or decreasing the amount of salt in our diets”.

I continued, “It is also important for us to understand that sodium is added to different foods as a preservative, eg- pickles, papads, bread, biscuits, wafers, ready to eat foods, sauces etc. So, we need to take into consideration the amount of sodium we consume from all sources.

Mr. Deshpande, a curious hypertensive, asked “Should I start with Himalayan Salt instead of regular salt?

Ah, and here comes the quintessential question! I took my time to answer this question. Did I want to tell him about all the types of edible salt that are there available in the Indian market- from table salt to kosher salt to sea salt to pickling salt to Celtic salt to seasoned salt to Himalayan salt (commonly known as rock salt or sendha namak) to kala namak. Well, I didn’t think he wanted to know that kosher salt are the large grains of salt used in kosher cooking (and I didn’t want to explain what kosher cooking was!). Or that sea salt is produced from sea water and has a lot of minerals OR that seasoned salt refers to a variety of salts mixed with herbs or spices.

So, I went straight to explaining him about the 3 most common types of salt we come across- Table Salt which is important as it is fortified with Iodine, Himalayan salt, which as per Ayurvedic texts has great health benefits (in diabetes, heart and osteoporosis) with 94 trace minerals with a lower sodium content than table salt and the Kala Namak (Black Salt) which has a sulphurous smell, rich in iron and potassium and lower in sodium.

Finally, I answered in a simple sentence, “Himalayan salt will be a very good option, but do not stop Table salt altogether.

Mr. Deshpande, a still curious octogenarian hypertensive, asked “So instead of regular table salt, should I take low sodium table salt?”

I thought of the Chemistry behind “low sodium salt” and the use of salt substitutes. I realized that advertisements and marketing of these salts failed to explain to the common man that Potassium is used as a salt substitute. Even though Potassium is good for the heart and muscles, it has its own drawbacks resulting in tremors, abnormal heart activity and high levels of potassium in the blood. I realized that people didn’t know that these salts with high potassium, were useful for hypertensive patients not on ACE inhibitors or ARB. This salt should be restricted in diabetics, during consumption of certain medicines, people with kidney and some liver diseases.

In this case, Mr. Deshpande was on ACE inhibitors for hypertension, so needed a low potassium intake. Thus, I asked him to continue with regular table salt and avoid low-sodium (high potassium) salts and avoid the other potassium rich foods as well.

Mr. Deshpande, the ever curious and intelligent octogenarian hypertensive, concluded for my benefit- He said, in a slow and precise speech, A hypertensive needs to reduce salt IF it is advised, where as a person with normal blood pressure values need not cut back on salt in the diet, though salt should be restricted to 1 tsp per day by everyone (including sodium derived from processed and preserved foods). Also, Low sodium salt is good for some people but not suitable for everyone or for all hypertensives. Different types of salt have different chemistries behind, and it is important to understand the composition of these salts before consuming.

I was impressed by the simplicity of his explanation and couldn’t have concluded better than him.

You can share this article with your friends on social media.You can read another article here ( Eggs- Are they good or bad for health ).

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Dt.Mansi Patil

Mansi is a Doctor.She has sound knowledge of Food, Nutrition and homeopathic Medicine.She done B.Sc. In Homeopathic Medicine and Surgery.She Done M.Sc. In Food and nutrition.She also done Doctor of Philosophy (PhD) in Health,Safety and Environment Field.She is a Research Fellow of International Society of Hypertension.She is a Regional Officer of Indian association of Parenteral and Enteral Nutrition.She is visiting Faculty for clinical nutrition module for Master in Public Health course.

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