Lies and half-truths you’ve been told about salt intake

It’s 5pm and Benson Kamau has just opened his daily business at Mirema estate, Nairobi. 

The father of two is busy serving his customers mutura, a popular Kenyan street delicacy. They surround a table fitted with a chopping board from where Benson is taking orders. 

“Most of them love a lot of salt and so I let them have as much as they want,” the 33-year-old  tells Healthy Nation during a visit. 

He says he doesn’t really care about the quantity of salt recommended by nutrition experts and doesn’t even know if such a thing exists. 

He narrates how his relatives have for decades consumed lots of salt yet they have never suffered any health complications.  

Michelle Muigai, 21, a restaurant manager who is based in the area, agrees with Benson.

“As long as the food has salt, I don’t care about the quantities of salt experts recommend and neither do customers because they even add more at the table at their own convenience.”

She says it all depends on the type of food being prepared. If the food has soup you may add more and “if I am using spices, I don’t usually put salt as many spices have it already.”  

Roy Bukhala , 25, a foodie and entrepreneur based in Nairobi, is of the view that enough salt is that which appropriately leaves a tantalising taste in his mouth.

“I am not conscious about the quantity of salt I consume, I only stop adding it when I feel the amount has hit the right spot.” 

Rogers Oliech, a 27-year-old bachelor who lives in Kiambu County, tells Healthy Nation that he doesn’t entirely agree with nutrition experts who say that adults should eat no more than six grammes of salt a day.

“I rarely taste food while cooking to see if the salt is enough because I have been cooking for myself for a long time and can accurately determine the quantity with my two eyes.” 

Chef Njathi Kabui and a leading expert in food literacy explains that all societies have stories about salt and those stories are of all different types from love to joy, betrayal and even revolution.  Some are in the Bible. 

“Salt has to be treated with a lot of respect. We should invest both time and money in ensuring that we are getting the right kind of salt,” Mr Kabui says. 

Salts are not the same and neither are they equal. Some salts in the market are highly processed and have added iodine and then there are salts that are mined in the ocean and others in salt mines. 

There is pink, black and white salt. 

Some salt is heated at high temperatures to keep it from caking while others are sold in crushed crystals, then there are salts that are smoked and others that are flavoured with other substances such as pepper or lemon peels. 

“Salt used to flavour tasteless food that is highly processed is mostly grown using toxic chemicals and these foods tend to be the ones with the least nutrients and flavour apart from causing cancer.”  

That means that such food has to have much more salt and artificial flavours to make it more attractive to the consumers, which also means that there is a lot of hidden salt in processed foods.  

The food expert points out that considering the fact that a lot of foods are not correctly labelled and many people are not as well equipped with the skills to understand labels, the right amount of salt and what kind of salt to be used becomes ‘problematic’.  

“What we need is a transparent food system and a food literacy to go along with it. It is a big lie that salt is just salt and if that is true, then we cannot have a standard for something we have not fully and clearly defined,” remarks Mr Kabui. 

Maryanne Mwanza, a consultant dietician based in Nairobi, tells Healthy Nation that salt, also known as sodium chloride, is the most significant source of sodium in the human body.  

“Dietary consumption of sodium is necessary to maintain proper water balance as well as muscle and nerve function. It is the excess consumption of sodium that poses a risk to health, leading to cardiovascular effects such as hypertension and stroke.”  

Ms Mwanza says sodium deficiencies are usually rare but can also occur, which can cause hyponatremia, a condition where abnormally low levels of sodium cause nausea, vomiting, altered mental state, seizures, coma and death. Low sodium levels can also cause hypotension (low blood pressure) and dehydration.  

“Less processed salt varieties may contain trace quantities of nutrients that do not pose any substantial differences; therefore they are better sourced from other foods such as fruits, vegetables, grains, nuts and legumes.” 

Table salt, usually extracted from ground salt, is commonly used and may contain anti-caking agents to prevent it from clumping while kosher salt is a coarsely grained salt used in traditional Jewish food preparation and is not usually iodised. 

On the other hand, sea salt is processed from evaporated ocean or sea water and may contain impurities found in the ocean such as lead, while Himalayan pink salt is harvested from salt mines in Pakistan and according to Ms Mwanza, the pink colour is characteristic of small amounts of iron oxide. 

“As part of a universal strategy to eliminate iodine deficiency disorders as a public health problem, table salt in Kenya is iodised. Iodine deficiencies are associated with thyroid problems such as hyper/hypothyroidism, goitre and enlarged thyroid glands, retarded fetal growth, and impaired mental growth and development of children.” 

According to the United Nations Children’s Fund (Unicef), iodine deficiency is the single greatest cause of preventable mental retardation, a problem that is easily and inexpensively prevented by consumption of iodised salt.

Early dietary exposure to sodium in infancy and early life may contribute to a preferential flavour towards salty foods in children, which is also very similar to packaged snacks targeted for children such as crisps and popcorn.  

“Salt quantities can be very high in other processed foods such as cured meats, canned foods, sauces, broths and stocks, salad dressing and processed cheeses,” she says. 

Foods can contain high amounts of salt without tasting salty, therefore people are advised to read the labels of food products before they purchase.  

According to the Centers for Disease Control and Prevention, the top 10 sources of sodium in  diets include breads and rolls; pizza; sandwiches; cold cuts and cured meats; soups; burritos, tacos; savoury snacks (chips, popcorn, pretzels and crackers); chicken; cheese; eggs and omelets. 

Salt is largely stable and therefore unchanged in low or high temperatures especially during cooking. 

“It is, however, very soluble in water and has more time to be distributed and absorbed in food during cooking to enhance the flavour of food,” says Ms Mwanza. 

Raw salt or salt added after cooking is more likely to be consumed in larger quantities. 

Ms Mwanza advises that those who need to cut down on their salt intake should start by reducing the consumption of processed foods, eat smaller portions of foods high in salt, use reduced or low sodium alternatives and prepare their own meals. 

In 2014 , the Kenya Bureau of Standards (Kebs) came up with what it described as a ‘salt standard’ developed by the Technical Committee on Nutrition and Foods for Special Dietary Uses under the supervision of Kebs’ standards projects committee. 

It stipulates the criteria for determining and categorising reduced salt content products and provides for the minimum mandatory labelling requirements that it said shall be applied on any food label that declares or claims any form of reduced salt content in its products as well  as a basis of certifying products, which may wish to claim on voluntary basis the aspects associated with reduced salt content. 

“A number of studies including those published by World Health Organization (WHO) have demonstrated a direct relationship between salt and blood pressure and that decreasing salt intake reduces the long term risk of cardiovascular events and stroke,” Kebs stated.

WHO has recommended reduced salt intake as a key strategy and an affordable public health intervention for cardiovascular diseases.  

The standards regulator goes ahead to recommend salt quantities for consumption. 

“Salt free content - maximum 0.25 mg/100g , very low salt content - maximum 40 mg/100g  and low salt content - maximum 120 mg/100g ,” Kebs highlights. 

Abnormally low amounts of sodium in the blood causes a condition called hyponatremia, which occurs mainly in older adults, particularly those living in long-term care facilities or hospitals who take medications or have health conditions that deplete the body of sodium. 

Too much sodium in the blood is called hypernatremia. This acute condition can happen in older adults who are mentally and physically impaired who do not eat or drink enough, or who are sick with a high fever, vomiting, or infection that causes severe dehydration.  

According to Dr Chulaporn Roongpisuthipong, clinical nutritionist, Diabetes Programme, Bumrungrad Hospital, more serious side effects occur when consumers ingest high amounts of salt over long periods of time.  

“The increased level of sodium in the bloodstream reduces the kidneys’ ability to remove water, therefore increasing the overall blood volume and placing stress on the body’s blood vessels,” he says. 

High blood pressure can eventually lead to strokes and congestive heart failure. As the kidneys constantly work overtime to flush out excess salt, one can develop kidney disease. 

Consuming too much salt over long periods of time can also lead to fluid collecting in the body’s tissues and cavities. Additionally, a high sodium diet may cause the body to excrete calcium in small amounts, which can eventually lead to osteoporosis.
 “Common short term side effects of consuming too much salt include swollen hands and feet or a swollen face. Some people become bloated because of water retention or feel excessively thirsty after a salty meal,” he explains. 

For men and women 14 years of age and older and pregnant women, the optimum intake of sodium is 1,500 milligrammes (about two-thirds of a teaspoon) a day according to the American Heart Association. The amount should never go beyond 2,300 milligrammes (a bout one teaspoon) 

Due to increased awareness in the general population, Kebs notes, the food industry is slowly and on a voluntary basis reformulating their products and reducing salt as part of ingredients and attaching claims of reduced salt content.  

In addition, public health practitioners such as dieticians and nutritionists are encouraging populations to consume foods with low sodium content in an effort to prevent or manage cardiovascular related conditions. 

In England, the National Health Service asks the public to be on the lookout.

“If you routinely take an effervescent (dissolvable) vitamin supplement or take effervescent painkillers when necessary, it’s worth remembering that these can contain up to 1g salt per tablet.” 

People may therefore wish to consider changing to a non-effervescent tablet, particularly if they have been advised to watch or reduce their salt intake.

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