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Health Bulletin - 2

Multiple research studies demonstrate that salt consumption is a significant contributor to several chronic diseases. In this issue, we will bring to your attention couple of case studies using this ‘silent killer’ and provide suggestions on disease prevention and progression.

Inconvenient truth about salt

We never think of salt until we get the message from our physicians “your blood pressure is too high, you should stop eating salt”! The news comes as a shock to the patient and to the loved ones. Most of the people decide to practice good health habits only after a serious health problem has occurred. The majority of these problems actually have their beginnings in the early years of life. Once diseases such as high blood pressure, diabetes, heart disease etc., have developed, it is already too late. The best we can hope for is to keep them under control. They cannot be cured. We have to place a much stronger, higher priority on prevention than on treatment.

So what’s the problem with eating salt? Multiple research studies demonstrate that salt consumption is a significant contributor to hypertension, heart problem, dementia (loss of memory), osteoporosis, stomach cancer, obesity, asthma and cardiovascular disease.

The International Federation and Society of Cardiology convened a multinational study called INTERSALT to answer the question, “What is the connection of adding salt to our food to developing high blood pressure?” This massive study involved over 10,000 people from 52 population groups from 32 countries across the world. Multiple international organizations, including the NIH, participated in and supported this study. The study demonstrated that the more salt added to the food the higher was the blood pressure [1]. Another study called Trials of Hypertension Prevention, collaborated by NIH, UPenn, Johns Hopkins, and Loyola University of Chicago, involved 744 people at 10 different locations and studied for 12 months. The conclusions were very clear: salt has a direct causal relationship with high blood pressure [2].

Blood constitutes plasma (colorless liquid), red blood cells and many other components. Salt concentration in the plasma and inside the red blood cells has to be kept exactly the same. If the salt concentration in the plasma exceeds the salt concentration inside the cell, some fluid from within the cells goes out into the plasma. As a result, the cells shrivel up and die. If, on the other hand, the salt concentration in the red blood cells exceeds that of plasma, then the fluid enters the cells trying to equalize the concentration. Then, the cells swell up and eventually burst. Adding more salt to what is naturally present in food creates a problem for the body to maintain the exact concentration of electrolytes. The kidneys maintain this crucial balance mainly by controlling the composition of urine. But, as it turns out, the kidney cannot completely get rid of all the excess salt we consume, especially over a long period of time. To maintain the necessary balance between the fluid inside and outside the cells, the kidney compensates by retaining more water to make up for the excess salt not removed. Thus, the volume within the system increases, but the size of the system of blood vessels itself remains unchanged. The increased volume circulating in the unchanged system increases the pressure within the system (high blood pressure).

Further, high blood pressure over time damages the inside lining of arteries due to high friction and shearing forces, particularly at the turns and bends of the arteries. Cholesterol is prone to deposit wherever there is damage to the inside lining of the arteries. These deposits eventually block the flow of blood. Once there is fat buildup, one may have to go through a horrific surgery such as coronary artery bypass. Patients are shocked when they see the specimen removed from their arteries after surgery. The ugly irregular-looking pieces of fat deposits are hard as rock and rattle when shaken in a bottle! Once cholesterol deposit begins, it keeps rapidly increasing. Growing cholesterol deposits in the wall of the artery cause the path for blood flow to become progressively smaller and eventually stops altogether. Heart attack may occur when portion of the heart muscle actually dies from the lack of oxygen. Cholesterol buildup affects arteries of many other parts of the body as well. Stroke, kidney failure, and loss of circulation to the legs etc., are some of the other well-known consequences of blocked arteries. All this agony can be mitigated simply by cutting down the salt intake.

A clinical study conducted by Indiana University researchers demonstrated that reducing salt intake for just two weeks alters airway inflammation [3]. In this study, the lung function improved and bronchial reactivity decreased with just 2-5 weeks of low sodium diet, while sodium loading made it worse. Exercise-induced asthma also decreased by maintaining salt reduction only for 1-2 weeks. The lung looks like a kitchen sponge, full of small air cells. Each of these small air cells (alveoli) connects to the main breathing passage (bronchiole). In asthma, the main breathing passage is inflamed, which narrows the passage for air exchange. Quick spasms of already swollen bronchioles close the passage, further triggering an acute asthmatic attack. Excess fluid (accumulated due to salt intake) around the small breathing passages is a set-up to trigger asthmatic attacks more easily.

Osteoporosis, affecting nearly all post-menopausal women, is also connected to salt. Salt in the food causes calcium loss by the kidneys, which in turn causes osteoporosis. Osteoporosis burden is six times greater than breast cancer.

Obesity is another major current health problem. There is a natural mechanism in the body called satiety, which is responsible for telling us when we are full and don’t need to eat anymore. Salt and other condiments bypass this ‘stop’ sign and make us eat more. No major study is necessary on this one. Test it yourself. We end up eating lot more food than needed, and become overweight or even obese. It is not really about a person’s appearance. There is plenty of evidence that obesity promotes diabetes, high blood pressure, heart disease, cancers, joint disease and more.

Few FAQs

I enjoy eating, what is the point of simply living long without enjoying life?! It is not only a matter of living longer; it is the quality of life in later years. As a consequence of adding salt to your food, you will have many medical, financial, and social difficulties in later years. The disabilities will be prolonged, painful, and costly. You are really not going to enjoy your later years as much as you expect to. Secondly, most people are prescribed some dietary restriction from about the age of 50 years anyway, some even earlier. They have great difficulty in adhering to such restrictions and do so begrudgingly. Transition to food with no added salt, however, is not that difficult. Once you make this successful transition, you will not miss all that excess salt. You will still enjoy the food (without salt) and be healthier as well as more functional in the long run.

Isn’t salt necessary for the body? Indeed salt is necessary for the body. But salt is already present in just about any food. There is no need to add more salt while cooking or to food already on the table.

OK, but my tongue has grown so accustomed to the taste of salt after so many years. How can I give it up? Fortunately, unlike tobacco, alcohol and narcotics, the taste of salt is not addictive. First, entire family should agree to cut down salt intake to avoid unnecessary arguments at dinner time! Second, plan on gradually reducing salt intake over a period of couple of months or at your own pace. You may fall of the path but don’t be discouraged. You are very likely to be successful. Watch out the top ten most unwanted items: pickles, salted crackers, salted potato chips, pizza made with salty dough, salted nuts, canned soups, lunch meats, many varieties of cheeses, carbonated drinks, boxed cereals.

You will reach a stage when you actually enjoy the taste of your food without salt; you don’t miss or crave for the taste of salt at all. At this point, when salt is added, you actually don’t like that taste anymore! Historically, salt was added to food as a preservative. Not for taste.

Good luck.


[1] INTERSALT: an international study of electrolyte excretion and blood pressure. Results for 24-hour urinary sodium and potassium excretion: British Medical Journal, 297: 319-329 (1988)
[2] Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP): Cook NR et al., British Medical Journal 334, 885-888 (2007)
[3] Dietary sodium intake and asthma: an epidemiological and clinical review. Mickleborough TD and Fogarty A, International Journal of Clinical Practice, 60, 1616–1624 (2006)
[4] Salt Kills by Drs. Neravetla and Neravetla (2012). ISBN: 978-1-938009-00-6


Vijay Gangula
Chair, Health Committee

Advisory Committee:
Surender Reddy Neravetla M.D., FACS