Salt has many detrimental effects on health and one of the most important risk factors for high blood pressure, the consequence of which is increasing the risk of heart attacks, strokes and heart failure as well as stomach cancer, osteoporosis and renal failure.
Many people from ethnic minorities living in the UK, including people of South Asian descent (accounting for around 4% of the total UK population (1)) are particularly sensitive to the effects of too much salt and therefore are at higher risk of associated health conditions such as coronary heart disease and stroke.
The effect of salt
Evidence shows that people of South Asian descent are at higher risk of high blood pressure and coronary heart disease (CHD). It has been predicted that people of South Asian descent are 30-40% more likely to die prematurely from CHD compared to the average UK population.(2,3) People of South Asian origin are also six times more likely to have diabetes than the average UK population, which doubles the risk of stroke (4) and are 3 -5 times more likely to suffer from end stage renal failure which can be exacerbated by high blood pressure. (3,5-7)
Despite being at increased risk of high blood pressure, stroke and renal failure, studies looking at the effect that salt reduction has on people of South Asian origin is limited. A recent randomised double blind cross over trial (7) showed that a modest reduction in salt intake of 4g/day for 6 weeks lead to a 5.4/2.2 mmHg reduction in blood pressure over the study period in mild hypertensive South Asian participants. This demonstrates the particular importance of salt reduction in this group to reduce blood pressure, CHD and stroke.
Figure 1 – Blood pressure and urinary sodium excretion after each 6 week phase of the crossover trial. (8)
Current salt intake
Almost everyone in the UK, and the rest of the Western world, eats too much salt. The daily recommended amount in the UK is no more than 6 grams a day and the current average salt intake is 8.6g salt a day (although many people are eating more than this). People with, or considered at risk, of high blood pressure should take extra care to ensure that they keep their salt intake below the recommended maximum of 6g.
Although for most of the UK population 75% of salt comes from processed foods, in the South Asian population almost all of the salt consumed is added during cooking or at the table. In fact, more than 90% of South Asian people (Indian, Bangladeshi, Pakistani) add salt to their cooking and 40% ‘generally’ add salt to their food at the table. Many add salt to their food without even tasting it first9. In South Asian cooking, the true level of salt added to food is often disguised by the hot spices used.
By using the advice below people of South Asian origin can help to reduce their risk of getting high blood pressure or if they already have high blood pressure, help to lower their blood pressure. Remember; the maximum recommendation for salt is no more than 6g of salt per day.
• Don’t add salt when at the table, and cut down the amount added during cooking. Remember that the maximum recommendation is 6g of salt per person per day which is just a teaspoon’s worth!
• If you gradually add less salt, your taste buds will adjust (it takes about 3 weeks) and you will not notice the difference
• Sea salt, rock salt and garlic salt are just bad for health as table salt and should all be avoided
• Most sauces used at the table are also very high in salt, e.g. chilli sauces, tomato ketchup and soy sauce. Everyone should look out for reduced salt versions or use sparingly
• When cooking, salt should not be added to the water used for cooking vegetables, pasta and rice
• Cut down on high salt snacks such as crisps, Bombay mix, salted nuts
• Check labels when buying ingredients, snacks or accompaniments. A low salt food has 0.3g or less of salt per 100g.
• Often sodium is listed rather than salt. Multiply the sodium level by 2.5 to get the salt level eg 1g sodium is 2.5g salt . Sodium could be listed in the ingredients as sodium bicarbonate or monosodium glutamate
• Butter and ghee are both high in salt and fat. Cut these out of your cooking by replacing them with olive or rapseed oil, or use unsalted versions.
1. National Statistics (2001). http://www.statistics.gov.uk/cci/nugget.asp?id=273. [accessed 07/07/2010]
2. Primatesta P et al. Blood pressure levels and hypertension status among ethnic groups in England. Journal of Human Hypertension. 2000; 14, 143-148.
3. Lip GYH et al. Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management. Journal of Human Hypertension. 2007; 21, 183-211.
4. Blood Pressure Association (2009) Love your heart: A South Asian guide to controlling your blood pressure. Page 10.4.
5. Cappuccio FP et al. Hypertension and ethnicity: prevalence and level of detection and management in the community in England. American Journal of Hypertension. 1997; 10, 22A.
6. Cappuccio FP. Ethnicity and cardiovascular risk: variation in people of African ancestry and South Asian origin. Journal of Human Hypertension. 1997; 11, 571-576
7. Kidney Research UK. 2008. Kidney health information PDF.
8. He et al. Effect of Modest Salt reduction on Blood Pressure, Urinary Albumin and pulse Wave velocity in which black and Asian mild hypertensives. Hypertension. 2009; 54, 482-488.
9. Health Survey for England 1999: the health of minority ethnic groups