Spanish gourmet chef Ferran Adria, who revolutionised haute cuisine with the iconic El Bulli restaurant, once said, “Salt is the only product that transforms gastronomy.” In Tamil, there’s a proverb ‘uppilla pandam kuppayile’, meaning, ‘a dish without salt is rubbish’.
As all seasoned cooks know, sodium chloride, or common salt, skews overall flavour. This is why coffee aficionados add an undetectable pinch to their grounds before brewing. Salt makes food sharper, suppressing bitterness, enhancing sweet and savoury, turning up the volume on aromas. Indians are addicted to it: we keep mixing shovelfuls of it in our chutneys, pickles, papads, churans, juices, instant noodles, pastas, biscuits, ready-to-eat cereals, bottled ketchups....
Five grams—just five grams, or under a teaspoonful—is the maximum salt you should have in a day. It’s a limit set by the World Health Organisation (WHO); the average daily consumption of salt per person in this country, according to who’s India office, is 9-12 grams.
The image of half a teaspoonful might serve as the alarming aide memoire Indians direly need. For we hardly ever scan the fine print on packets of ready-to-eat poha, oats upma or kadhi-rice to find out how much salt they will pump into the bloodstream. And who cares for the ladles of salt that went into that ladleful of chhole bhature! Despite its smorgasbord of additives like citrus zests, vinegars, herbs and spices, the Indian culinary universe has an unholy alliance with salt.
Consuming too much salt causes chronic hypertension and increases the risk of cardiovascular disease and stroke, which together result in 2.5 million deaths yearly—roughly 26 per cent of all deaths by disease in India. The INDIAB study (2014) of the Indian Council of Medical Research (ICMR) found the mean salt intake in urban India is 7.6 grams daily per person—higher than in the villages. Cause: junk food. “The mean salt intake is highest in Chandigarh, followed by Maharashtra, Tamil Nadu and Jharkhand. The higher prevalence of hypertension in urban areas could be attributed to increased salt intake in these areas,” says the study.
Globally too, death from cardiovascular disease has been on the rise—and linked to excessive sodium intake, which of course comes chiefly from sodium chloride or salt. The daily sodium consumption limit for adults is two grams.
Perhaps it’s biological. Studies suggest that babies whose mothers suffer from morning sickness tend to have above-average salt appetites because vomiting depletes sodium levels in the body (and the foetus). Other studies have explored, though inconclusively, whether individual preferences may be related to stress, anxiety or personality traits. Experts say habit plays a much bigger role in salt preference.
Like any dietary routine, if we get accustomed to saltier food, we need to maintain that level to continue to enjoy our meals. But foods high on salt substantially raise the risk of hypertension, and are associated with direct vascular and cardiac damage, obesity, stomach cancer, ostoeoporosis, kidney stones and increased severity of asthma symptoms. Among children, it’s leading to greater consumption of calorie-dense soft drinks because of heightened thirst levels; and childhood obesity is already at alarming levels.
The Annals of the New York Academy of Sciences show an upward trend of cardio-metabolic risk factors in India in the last 15 years. The percentage of people with hypertension has gone up in India from 17.2 to 29.2, and the percentage of obese people from four to 15.
Doctors know what they are up against. Cardiac surgeon Dr Naresh Trehan says, “Salt is used extensively in canned, preserved and junk food to induce craving. Increasing levels of sodium in our diets have created what amounts to a cultural addiction to salt. People need to be educated on moderation. It’s high time the government involved civil society to make a difference.”
Dr Subbarao M. Gavaravarapu, a health communication scientist at the National Institute of Nutrition, Hyderabad, thinks the processed food industry alone cannot be blamed. There are other dietary sources of sodium—like the indiscriminate use of additives rich in sodium or innate cultural habits. Dr Gavaravarapu cites the example of Kerala, which scores well on nutritional indicators—but when it comes to non-communicable diseases (such as hypertension and lifestyle-related cardiovascular disease), Kerala is placed low. He says lowering salt consumption should be taken up as a national programme.
Dr Anoop Misra, a Delhi-based endocrinologist, says we consume a lot of “invisible salt”, which is nearly impossible to track—the salt in bread and bakes, and of course, snacks, bhujias and mixtures. “We often hear people say they hardly cook with salt or put salt in their food,” says Dr Mishra. “They believe this means they have a low-salt diet, but actually sodium is hidden in all kinds of food. Nearly seven per cent of adolescents in India have high blood pressure. There should be more awareness and tighter regulations.”
But families are often in denial. Muskan Jain from Delhi is 15 years old and weighs 80 kg. Her mother Anubha says the teenager has an infection in the pancreas, vomits frequently and has severe stomach-aches and that she has been admitted to hospital many times. Muskan admits to a sedentary lifestyle and snacking at odd hours. Arkopravo Dey from Asansol is 14 years old and weighs 115 kg. “He can’t travel in buses, feels suffocated in crowded spaces, detests exercise and can’t concentrate on his studies for long,” his parents say.
Doctors have advised the teenager to check his diet and cut back on salt. “But there aren’t enough regulations here. We don’t even know if he’s hypertensive,” says his father. Paediatric hypertension remains largely understudied, under-diagnosed and undertreated. Even adults are negligent. Swagat Bopanna from Pune is 55 years old and can’t do without heaps of salt. “We are vegetarians and food has to be made tasty by adding more masala, pickles, papads and other condiments. Besides, sugar is the real threat. What wrong has salt done?” he asks. Estimates indicate that almost 80 per cent of people don’t consume adequate fruits and vegetables, which are high on potassium and can blunt the impact of sodium on blood pressure.
In 2012, the Centre for Science and Environment (CSE) in Delhi had tested for salt in Indian snacks and nibbles, and found it high in potato chips, bhujia, instant noodles and burgers. When Outlook tested some samples from popular haunts like Saravana Bhavan, Nathu’s and Shiv Sagar in Delhi, the results showed that a dish like a dosa or a pao-bhaji had enough salt for the whole day.
“Packaged food is ultra-processed, refined for palatability and hyper-flavoured. Foods high on sodium are increasing; so are non-communicable diseases,” says Amit Khurana, programme manager, food safety and toxins, CSE. But this isn’t only an urban phenomenon. There’s a proliferation of such snacks in the rural sector: besides the bigger brands, which are pushing into the rural market, there are clones of top brands. Hypertension is being spread through nitrogen-packed sachets.
Advisories from physicians’ associations don’t get converted into public messages; and there are no strict regulations on the advertisement of such products. Even labels aren’t people-friendly. “Food is multi-cultural in India, so functional advisories are necessary. Labels should be made available in local languages and they should be visually comprehensible,” says Rajib Dasgupta, professor at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University (JNU).
It is not as if snacks and fast food makers are unaware of the dangers of excess salt. But if they tried to sharply reduce the amount of sodium in packed foods, they’d have a revolt on their hands. As Ravinder Singh, managing director of Green Chick Chop, Delhi, points out, “If you compromise on taste, customers will not be interested. Earlier, we tried to reduce the oil content, but it left many people dissatisfied. In our culture, there’s a high demand for salt.”
Ravindra Dhingra of Panch Ranga Pickles admits chutneys and pickles are only meant to give your meal a zing, and are not the mainstay, but he says, “The addition of spices and oil may lessen the salty effect but there’s no alternative to sodium in preservatives. Also, no universal limit can be applied for salt in our diet.” Some manufacturers, however, have signalled their willingness to go healthy.
PepsiCo confirmed that they would slash the average amount of sodium per serving in key global food brands by as much as a quarter by 2020, against a 2006 baseline. Sanjay Sharma, CEO of MTR Foods, makers of popular ready-to-cook packets, claims the company has already announced a commitment to reduce salt drastically in all its products. “We will focus on a gradual process to reduce the salt content. We are working to minimise sodium in our ready-to-eats and ready-to-cook items.”
And yes, the salt habit can be unlearned too. Says Sriram Venkateswaran, director for product development at McDonald’s India, “In 2013, we reduced the salt in our french fries by 20 per cent. Simultaneously, we undertook a 10 per cent reduction in sodium levels in buns and sauces. People have adapted quite well to the new taste.” Amitaabh Ganguly, general manager at Haldiram’s in Calcutta, says the company is consulting scientists across the country and aims to reduce salt in its products. He says, “We are completely in agreement with the idea of a healthier and less salty India.”
Chefs, bakers and restaurateurs are also working to remove the salt-shakers from our dinner tables. Madhulika, sous chef at The Brew Room in Chennai, says, “If I’m making pumpkin or zucchini soup, the fresh ingredients provide natural flavouring to the consomme. If it’s a cheese-heavy dish, then I don’t complement it with a salty side.” Chef Vikas at Flurys in Calcutta talks about ‘healthy days/weeks’, during which customers are educated on blood pressure and the risks of having too much salt. Nakul Yadav, owner of Sugar and Spice Bakery in Delhi, has initiated a poster drive at his stores to warn people of the side-effects of too much sodium.
This should make nutritionists happy. Aanuja Agarwala, a dietician at the department of paediatrics at AIIMS, Delhi, believes advertisers must promote the use of natural condiments to enhance taste. Herbs and spices like amchoor, tamarind, fresh tomato puree, sea salt, basil, ginger and garlic can offset the absence of salt. Dr Agarwala says, “A multi-nutrient approach is required to counteract the unintended consequences of salt reduction, whereby producers go on to replace it with sugar or fat.”
Mumbai-based health and nutrition expert Anjali Mukherjee feels sugar is a hotly debated issue in India, but salt never takes centrestage. She says, “Looks, cosmetics and body weight motivate people most. So TV channels and new media should step in to spread more awareness.” How much salt you like is an acquired taste that can be altered. Rita Date, nutritionist and author of What’s for Lunch, points out, “It takes about six weeks to get used to eating food with less sodium. Once you get used to that, you’ll find most savouries way too salty.”
If health experts had their way, all of us would need to make major changes in our food choices, start reading labels and actively restrict sodium in our diets. But medical practitioners think government policies must restrict sodium in workplaces, schools and communities. Civil society feels advertisers can spread awareness.
Others think we can take a cue from Finland, which was able to reduce its per capita salt intake from 12 gm to seven gm over 30 years. But before (and if) the wheels start turning in the food industry, try a simple cut-back recipe: if you’re home cooking dinner, don’t salt a dish before tasting it. Use herbs, lime juice and vinegar, and knock out the saltshaker. And when it’s time for that sumptuous meal, remember what chefs always say: “Do you taste too much salt on your tongue?”
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