Indian adults consume between 8.5 grams and 15 grams of salt each day as against the World Health Organisation’s (WHO) recommendation of less than 5 grams per day to reduce blood pressure, heart disease and stroke, says a September 2012 paper in PLOS ONE.
And contrary to the WHO’s recommendation of at least 3.5 grams intake of potassium per day, Indians consume far less amount of potassium. Apparently, Indians on average consume 130 grams of fruits and vegetables per day as against the WHO recommendation of 500 grams a day.
Excess water in the blood is filtered out by the kidneys through osmosis. For this to happen, a balance of sodium and potassium is needed. But high intake of sodium alters this sodium balance, causing the kidneys to have reduced function and remove less water resulting in higher blood pressure. This puts strain on the kidneys and can lead to kidney disease.
According to the President of the Public Health Foundation of India (PHFI), Prof. Srinath Reddy, hypertension in the population ranges from 20-39 per cent in urban areas while it is 12-17 per cent in rural areas. An October 2014 paper in the journal BMJ Open says that an estimated 140 million people in India have hypertension, a figure that will touch nearly 214 million by 2030.
If a high proportion of salt consumed by Indians comes from salt added while cooking and at the table, a much higher intake comes from consuming processed food, especially salted snacks, pickle, papad and sauce.
Vast differences revealed
A survey of nearly 5,800 packaged food products reveals huge differences in the salt content of similar foods. For instance, cooking sauces, table sauces and spreads were found to contain on average 5.5 gram per 100g of salt, with some having 10 times that amount.
What makes it difficult for consumers to choose healthy food items is the lack of labelling information about sodium on most packaged food products sold in India. A September 2015 study (Asia Pacific Journal of Clinical Nutrition) carried out in 2010 found that only 31 per cent of Indian food products included information on sodium in the nutrition labelling.
Nothing much seems to have changed since 2010. The survey of 5,800 products carried out from 2013-2014 found that only a third of packaged food products had information on sodium.
It is ironic that despite the high incidence of elevated blood pressure in India and high hypertension-related mortality, the Food Safety and Standards (Packaging and Labelling) Regulations, 2011, has not made it mandatory for manufacturers to provide sodium information. Making sodium data available on packaged products is vital in helping a person wanting to reduce his salt intake.
According to the 2011 regulations, manufacturers are required to provide nutritional information on ‘energy, protein, carbohydrate, sugar and fat’. Declaring the sodium content on the label is not mandatory. However, Codex requires labelling to also include information about saturated fat and sodium.
But if everything goes to plan, salt (sodium) content may soon be available on the packet labels of food products. According to the former director of the Hyderabad-based National Institute of Nutrition, Dr. B. Sesikeran, and till recently the chairperson of the FSS Scientific Panel on Labels, a revised Food Safety and Standards (Packaging and Labelling) Regulations will be notified soon.
A front-of-pack labelling will include salt (sodium) in addition to total calories, total saturated fat, trans fat, and added sugar. The FSS may also make it mandatory to include markings on whether the five categories on the label are ‘low’ or ‘high’ per serving.
In an email to me, Dr. Shweta Khandelwal, Associate Professor at PHFI says: “Added salt in mg/serving size should be included under the mandatory labelling component. The food industry will always bring up something which will delay or digress from this issue but we need to advocate it in a concerted fashion in light of the already existing and constantly rising epidemic of chronic diseases.”
Inclusion of salt (sodium) on labels will be a welcome step and will be in line with the WHO’s January 2013 guidance to include food and product labelling to reduce sodium and increase potassium consumption. The government should next negotiate with food manufacturers to reduce the amount of salt in processed foods.
Other countries have adopted several proactive measures to cut down on salt consumption. For instance, in South Africa , a new draft regulation sets requirements for voluntary colour coded front of pack labelling for energy, total sugar, fat, saturated fat and total sodium or salt equivalent per serving. The regulation was subject to public consultation until the end of August 2014 and the final version is about to be released, says Dr. Khandelwal. While in the case of other countries like Brazil, China and the U.S., salt-reduction strategies have been initiated in select regions.
The ‘salt’ app
Meanwhile, the FoodSwitch app developed by the Sydney-based The George Institute for Global Health will provide consumers with the knowledge and support to choose products that are healthy. The George Institute for Global Health India already has nutrition information on nearly 8,000 food products sold in India across 15 food categories. Another 2,000 products will soon be added to the list.
The free to download app uses the established traffic light labelling system — red (‘high’), amber (‘OK’) and green (‘good’) — to evaluate products in the chosen category.
“The app serves like an advocacy tool for consumers to use the information available on the label,” says the Deputy Director of The George Institute for Global Health India, Delhi, Dr. Pallab Maulik. “If and when India makes it mandatory to have all the details on the label, the app will still be useful in helping consumers choose healthier options.”