The truth about salt: how to avoid one of the world’s biggest hidden killers | Food

Last Tuesday, I bought lunch on the go. I fancied something hot, tasty but healthy, so I chose a vegan ramen from the Japanese-inspired chain Wasabi. The soup was packed with turmeric noodles, vegetable gyozas, mushrooms, bean sprouts, pak choi, pickled ginger and sesame seeds, in a soy and miso broth. It was delicious. In fact, it was so delicious, I was suspicious. I checked out its nutritional information online. Only 342 calories, low in saturated fat … Aha! Salt: 5.07g a portion.

The World Health Organization recommends that adults eat less than 5g of salt a day. One noodle soup had exceeded my entire daily intake. (The UK limit is a little more generous at 6g, but even that wasn’t far off.)

What’s the big deal? Well, as a one-off, it would be fine. But this wasn’t a blowout, special occasion meal – it was a “healthy” lunch on a work day. And Wasabi is not unusual in using so much salt. This ramen illustrates how easy it is to exceed your recommended salt intake. In fact, it is nigh-impossible to stay within the limits.

The average British adult eats 8.4g of salt every day. That’s 40% above the UK’s recommended maximum, and almost 70% above the WHO’s recommendation. This matters. Excess salt consumption is linked to high blood pressure (hypertension), and hypertension is the leading cause of heart attack and stroke. “Thousands of people in the UK die needlessly each year due to high salt intake,” Action on Salt said in its response to the autumn budget. According to the group, if everyone in the UK ate 1g less salt a day, it would prevent more than 4,000 heart attacks and strokes every year.

The British Heart Foundation (BHF) has calculated that, if every adult in the UK met the WHO salt-consumption guidelines by 2030, by 2035 there would be up to 1.4m fewer new cases of high blood pressure, up to 135,000 fewer new cases of coronary heart disease and up to 49,000 fewer new cases of stroke. The WHO has said: “Reducing sodium intake is one of the most cost-effective measures to improve health and reduce the burden of non-communicable diseases.”

Even people already taking medication for hypertension can significantly lower their blood pressure by halving their salt intake, according to a report published in September.

Unlike, say, excess sugar, which can cause tooth decay, weight gain, skin problems and mood swings, the effects of too much salt are hidden. “There are no visible symptoms or side-effects,” says Sonia Pombo, the campaign lead for Action on Salt and a research fellow at Queen Mary University of London. “It is thought that there are 5 million people with undiagnosed high blood pressure in the UK. It’s a ticking timebomb.”

Heart attack and stroke are not the only things to worry about. Excess salt is also linked with stomach cancer, kidney disease and osteoporosis. “We should be doing all we can to reduce our salt intake,” concludes Pombo.

The dangers of too much salt have long been known. The UK’s 6g limit – a level teaspoon – was set in 1991. In 2002, the Food Standards Agency committed to a nationwide salt-reduction initiative. “Between 2003 and 2011, we made huge strides. Population salt intakes were down by 15%, blood pressure was down, deaths from heart disease and stroke were down,” says Pombo. The FSA set the first salt-reduction targets for 85 categories of food in 2006. These targets were voluntary but closely monitored, and manufacturers got on board. “The UK was world-leading, and helped countless other countries start salt-reduction programmes,” says Pombo.

Since 2011, progress has plateaued. “There are still targets and a salt-reduction programme, but companies aren’t being held accountable. Without monitoring, assessment and engagement, there’s no incentive for business to make changes,” says Pombo. “There have been no further reductions, salt intake is creeping up again, and blood pressure levels and rates of heart disease have stalled.” While Argentina, South Africa and several European countries now have mandatory salt-reduction targets, the UK has been left behind.

Experts are hopeful that Labour will kickstart the salt campaign again. Keir Starmer has appointed a new minister for public health and prevention, Andrew Gwynne. As Dr Swrajit Sarkar, a senior lecturer in nutrition at City, University of London, says: “The Labour government seems to understand that prevention is better than cure.” Pombo welcomes the pledge in the budget to review – and hopefully expand – the successful sugar tax on soft drinks, as well as last month’s House of Lords report, A Plan to Fix Our Broken Food System.

Ultimately, campaigners would like to see a salt levy and mandatory reduction targets to force manufacturers and caterers to reformulate their food. Thirty-five groups signed an open letter earlier this month. But it is a long process. “Salt is one of the cheapest sources of preservation, and a traditional one. Reduction needs investment into new preservation techniques,” says Sarkar. “If we banned salt overnight, prices would go up. Food would have a shorter shelf-life, waste would increase and carbon emissions would go up.”

A spokesperson for the Department of Health and Social Care said: “We are taking a range of actions to tackle unhealthy diets, including high salt intake, head on. Through the 10-year health plan [due to be published in spring 2025], we are shifting our focus from treatment to prevention to ease the strain on the NHS and help people to live well for longer. This includes restricting junk food advertising on TV and online, and limiting schoolchildren’s access to fast food.”

In the meantime, what can individuals do to reduce their salt intake? “Up to 85% of the salt we eat is already in our food, which makes it really hard to eat within the guidelines,” says Kate Howard, the coordinator of the Recipe for Change campaign. “People don’t realise how much hidden salt is in certain foods,” adds Sarkar. Pombo puts it more starkly: “We have been robbed of our choice to have a lower-salt diet.”

“The best thing you can do is cook your own food from raw materials,” say Sarkar. Since cooking from scratch 100% of the time is unlikely to be feasible for most of us, what are the other options? Knowing which foods are high in salt is a good start. “The main contributor of salt to UK diets, because most people eat it on a regular basis, often multiple times a day, is bread,” says Pombo. “It is the biggest by far, contributing 15-20% of our total salt intake.” Varying your carbs could help, then.

The next biggest sources of salt, in order, are bacon, ready meals, cheddar-type cheeses, pizza, soup, ham/cured meats, salted butter/spread, sausages, baked beans, breakfast cereal, biscuits, potato crisps, pasta/cook-in sauces and stock. Some of those, such as bacon, are obviously salty; others, such as baked beans and biscuits, may be more surprising. “Half a gram here, a quarter there, it all adds up,” says Pombo. Tracy Parker, a senior dietitian at the BHF, says other surprisingly salty foods are frozen prawns, tinned vegetables (many are in salted water) and packaged cakes. Plus, “vegetable juices such as tomato juice often have added salt to ramp up the flavour”.

“Read the label to compare like-for-like products, and choose the ones that are low in salt,” Parker advises. “The amount of salt in baked beans, breakfast cereals and bread can vary widely.” Some brands have cut salt levels voluntarily – Pombo singles out the Goodfellas pizza range, which has been reformulated to reduce the content of salt, sugar and saturated fat. The traffic-light labels on the front of packs are a handy shortcut, although not every product displays them (they are neither mandatory nor standardised). The FoodSwitch UK app is a useful tool – you can scan the barcode to see if a product is high in salt, and if so, the app suggests alternatives.

Other high-salt products Parker flags include: smoked food (meat, fish, cheese, tofu); sauces and condiments such as ketchup, soy sauce, salad dressings and gravy granules; anchovies and olives, especially those in brine; fermented and pickled food; and some meat substitutes, such as faux meat and fish. Some of these are healthy additions to the diet – olives, kimchi etc – as long as they are eaten in moderation.

The problem is, salty food is delicious. “Salt is a natural flavour enhancer,” says Sarkar. “We don’t want bland or bitter food; we crave something salty or something sweet.” But, he adds, “the more salt you have, the more you want – you become addicted to it”.

There is some good news. “Our taste buds can adapt to less salt,” says Parker. “The key is not to go cold turkey. If we slash salt levels too quickly, our palates can’t take it. You have to retrain your taste buds gradually. Be patient, and give yourself three to five weeks to adjust.” She suggests weaning yourself off salt in cooking water; experimenting with other flavourings, such as herbs, spices and citrus juice; and not having salt on the table. Last year, a study found that people who never add salt to meals were 18% less likely to develop the heart condition atrial fibrillation. “When you’ve cut back, you really notice when a restaurant meal is salty,” says Parker.

Surely fancy salts aren’t as bad as cheap table salt? My beloved Maldon sea salt sits on the kitchen counter by the hob, and my cupboards contain smoked salt, Himalayan pink salt and kala namak (black salt). “Himalayan rock salt contains tiny levels of micronutrients but exactly the same level of sodium as table salt,” says Pombo bluntly. “Things like Maldon sea salt have much bigger salt crystals so they don’t taste as salty, but they are – and you might end up adding more.”

Is it a good idea to switch to a salt substitute such as LoSalt? “These mix sodium chloride with potassium chloride, so they’re lower in sodium and can be useful if you still want a salty flavour,” says Parker. “However, they don’t help with kicking the salty habit – it’s better to adjust your palate so you’re not craving salt.” Potassium-based substitutes are also not suitable for people with heart and kidney problems: if in doubt, check with your doctor.

For me, salty snacks are the hardest habit to kick. “Go for unsalted nuts, reduced-salt crisps, plain popcorn or breadsticks, and fruit. There are more low- and no-salt foods available now,” says Parker. That sounds a bit dismal. Personally, I’d rather cut out other sources of salt, and still treat myself to the odd bag of crisps.

Shopping and cooking is one thing, but what about food on the go and in restaurants? “It’s so much harder to keep track of salt when you’re eating out of the home,” Parker says. “If you know which foods are generally high in salt, you can avoid them in your lunchtime sandwich – cheese, processed meat and so on. With salads, be aware of the add-ons such as croutons and dressings.” In hindsight, my ramen – which seemed so virtuous – had some salt flags: broth, condiments, pickles.

“Restaurant food and takeaways are absolutely covered in salt,” says Pombo. She says chefs get used to the salty taste, and often end up adding more and more. “We don’t expect sugar to be already added to our takeaway coffee – so why is salt added to everything?” A report in August on the 10 bestselling items at the 20 biggest chains in the UK, including Costa, Pret a Manger, Pizza Express and Wetherspoon’s, found that just 22% to 54% could be considered “healthier”. Optimistically, Parker says: “Some restaurants have nutritional information online, so if you’re really organised you can have a look before you go out. And always taste your meal before adding salt.” She suggests choosing fresh meat over processed, and thinking about, say, which pizza toppings and pasta sauces might be high in salt. “Little changes go a really long way.”

The effects of excess salt aren’t felt equally. According to Action on Salt, many people from ethnic minorities, including people of black African and South Asian descent, are particularly sensitive to salt and are at higher risk of associated health conditions. Older people are more at risk, too: over time we all become more sensitive to salt, and it has a greater effect on blood pressure, which increases with age anyway. And those on lower incomes are more likely to eat excess salt due to the lack of available, affordable healthy food. For example, says Pombo: “There are probably five or six varieties of the most popular brand of ketchup, including low- and no-salt, but the cheapest will always be the big bottle of standard high salt and sugar.”

Is it possible to eat too little salt? In a word, no. Sodium is naturally present in many foods, and we only need 1g of salt a day – about a pinch – for our bodies to function. Even if you do a lot of sweaty exercise, you’re highly unlikely to need extra salt. “Big sweaters do lose some sodium, but most of us are getting more than enough, so you don’t need to compensate,” says Parker. Just drink plenty of water. “Elite athletes lose sodium, potassium and other minerals, but they have sports drinks and rehydration tablets designed for them.”

Of course, preventing hypertension is not just about limiting salt. “Regular exercise, cutting down on alcohol and watching your weight is beneficial to your blood pressure, too,” says Parker. “And it’s really important to get it checked. The NHS is in crisis, and this is one of the ways to help.”