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‘A Little Pinch Will Do You’ Written by Kathleen Alleaume Accredited Exercise Physiologist and Nutritionist We are probably the fi rst generation since the beginn ing of the world to be paranoid about salt. We would all die without salt. Jeffrey Steingarten, American Vogue Food Editor & former laywer (1997) Back to Basics Salt is a dietary mineral composed of two elements: sodium and chloride. They are an essential element of life. Both sodium and chloride are not manufactured by the body, so must be supplied by the diet. Salt is one of the four primary elements of taste (the others are sweet, sour and bitter). It has historical links to politics, culture and religion – all because of the body’s compelling biological need for salt. History of Salt Salt is unequally distributed around the planet and mined in many different countries. For many years, it was thought to be a luxury item, accessible only by the wealthy. The Roman soldiers were paid with salt – hence the origin of the word “salary”. In China, salt bars stamped with the emperor’s seal were created and used as currency. Salt gave Venice its start in the sixth century as the commercial capital of Europe, caused the French Revolution, nearly defeated Mao Tse-tung, and helped Ghandi bring India to independence. Salt is the world’s oldest food additive. Before recorded history, man learned salt’s key role in food safety and preservation. Today, food technologists rely on salt to satisfy consumer preferences in colour, texture, appearance and aroma. Salt was, and continues to be, used in religious ceremonies as well as for medicinal purposes. Many believe it wards off evil spirits and demons responsible for illnesses. Today salt is abundantly available and inexpensive. In many places, along with bread, salt continues to be a symbol of friendship and hospitality. Expressions such as “salt of the earth” and “take (a story) with a grain of salt” reinforce its significance in many cultures. The earliest roads were built to transport salt, the earliest taxes were levied on it and military campaigns were launched to secure it. 1 Types of Salt Graph 1 2 All salt comes from the sea. Even inland salt mines are mining deposits left by prehistoric oceans. Roughly half of the salt we consume is extracted from the sea, the other half from inland deposits. Table salt Sea salt crystals Sea salt which has been finely crushed into small-sized identical crystals. Sea salt which has been crushed into large-sized crystals. • Uses: sprinkle over food to taste when served. • Uses: Use for cooking, curing food, food presentation or in grinders. Coo king salt Iodised salt Sea salt which has been crushed into medium-sized identical crystals. Salt that has added potassium iodate. It is available in sea salt crystals, sea salt flakes, cooking salt and table salt. • Uses: Add to food during the cooking process. Sources of Dietary Iodine (micrograms) Sea salt fl akes Sea salt which has been evaporated into unique flake-shaped crystals. • Uses: Crumble over food either during cooking or to taste when served. Why add Iodine to Salt? Iodised salt was invented early in the 20th century to help address widespread iodine deficiencies. Iodine is a mineral that is essential for proper function of the thyroid gland and cannot be manufactured by the body. Salt is an ideal way to consume iodine because it doesn’t spoil and is consumed by the population in fairly predictable amounts.1 Iodine’s richest natural sources are sea life such as seafood and seaweed. However, it is also present in plants grown in iodinerich soil, as well as meat, eggs and dairy products where iodine has been used during processing (although a less common practice now). See Graph 1. A lack of iodine in the diet causes a wide spectrum of adverse health effects (see Table 1). These effects are a result of the decreased function of the thyroid hormone. The thyroid gland is a critical part of the endocrine system. Its purpose is to secrete thyroid hormones which regulate the rate of metabolism, energy production, reproductive function in adults and growth and development in children. For pregnant or breastfeeding women, an iodine deficiency could increase the risk of miscarriage, still-birth and premature birth. Symptoms associated with iodine deficiency can range from person to person. In adults, iodine deficiency can lead to a range of health problems including hypothyroidism, impaired mental and physical function, reduced fertility and increased susceptibility to thyroid cancer. Children who do not receive enough iodine, in the womb or as they grow, can suffer from life-long debilitating health and developmental concerns including impaired motor skills, hearing and speech problems, a lower IQ, learning difficulties and stunted growth. Did You Know? 75% of salt in the Australian diet comes from processed foods. Table 1 3 Stage of life Adverse effect of lack of iodine Adult Goitre (swelling of the thyroid gland), hypothyroidism (under active thyroid), impaired mental and physical function, reduced fertility, increased susceptibility to thyroid cancer. Child and adolescent Goitre, hypothyroidism, impaired intellectual performance, retarded physical growth, increased susceptibility to thyroid cancer. Foetus Miscarriage, premature birth, brain damage (including intellectual impairment), hearing loss, increased perinatal mortality (death). 3 Iodine is also an important part of a baby’s neurological development. Once a child has been affected by an iodine deficiency disorder, the effects are irreversible. Did You Know? SAXA salt was established in Australia in the 1930s and remains the market leader today, with 70% market share. SAXA offers a range of iodised salt products that include rock salt and sea salt flakes. According to Food Standards Australia and New Zealand (FSANZ), an estimated 70 per cent of women of child-bearing age and 10 per cent of children are iodine deficient. The good news for Australian mums is that identifying and correcting their iodine levels early on in their pregnancy (and whilst breastfeeding) is very simple. How much iodine do we nee d? One teaspoon of iodine is all you need in a lifetime! However, the thyroid gland does not have the capacity to store a large amount, so small amounts must be consumed regularly (see Table 2). Table 2 Daily iodine intake recommendations by the NHMRC (micrograms/day)4 How do I prevent iodine defi ciency? Infants 90–110 Children 90–150 The best way to beat iodine deficiency is by making some simple changes to your diet: Adults 150 Pregnancy 220 Lactation 270 • Two to three serves a week of seafood will provide sufficient intake of iodine. • Replace regular salt with iodised salt. A small pinch per person of iodised salt each day is a simple way to ensure your family’s diet contains iodine. It allows home cooks to control the level of salt in the family’s food. • Incorporate healthy snacks, such as fresh fruit and low-fat dairy products. • Reduce your consumption of processed foods. • Include lots of fresh vegetables in your diet. • Make good choices at the supermarket by choosing bread that contains iodised salt. Note: breads that you buy at the markets or from gourmet bakers may not contain iodised salt. What happ ens to excess iodine? Iodine defi ciency – An emerging issue The decline in iodine intake appears to be due to changes in diet and food manufacturing practices. These include: Historically, parts of Australia have experienced iodine deficiency due to domestic food supplies being grown in soils low in iodine. Recent studies have indicated that mild iodine deficiency has re-surfaced over the last 10–15 years. As a result, iodine deficiency is a re-emerging problem, and is fast becoming a major one. • Less iodine in milk because of changes in treatment methods. • A possible reduction of iodine levels in Australian soils. • A reduction in the use of cooking and table salt (particularly iodised salt). • Limited understanding of the health benefit of iodine generally.7 The Australian National Iodine Nutrition Survey 2003-2004 found that almost 50% of school children (aged 8-10 years) are mildly to moderately deficient in iodine. Further, the latest Australian Total Diet Study found a total of 43% of Australians aren’t getting enough iodine, while 70% of women of child-bearing age and 10% of children between the 2–3 years are iodine deficient.6 How does Australia compare to other countries? According to the International Council for Control of Iodine Deficiency Disorders’ 2008 Iodine Deficiency Global Scorecard, Australia is listed behind China, the United States of America, Germany and South Africa (see Graph 2). Graph 2 Did You Know? There is a correlation between Mums being iodine deficient and other family members being iodine deficient, as Mums prepare the family meals. Up to 1000 micrograms of iodine per day is well tolerated by most adults, as the thyroid gland is able to adjust to a wide range of intakes. However, children and people with pre-existing thyroid problems may be more sensitive to large amounts, and will therefore need to seek medical advice for individual dietary needs. The kidneys regulate the amount of sodium the body needs by excreting excess amounts.5 How do I know if I’m iodine defi cient? A person may have low iodine levels without showing symptoms. The most reliable way to check your iodine intake is to ask your doctor to order a urine test. Your doctor may also use a blood test to ensure that your thyroid hormone levels are normal. Proportion of population with low urinary iodine levels (less than 100 micrograms per litre)8 5 New foo d standard Did You Know? Salt is the only mineral we eat straight from the ground? In response to the re-emerging issue of iodine deficiency in Australia, the national food regulator, FSANZ, has developed a new standard which requires non-iodised salt in all bread (excluding organic) to be replaced with iodised salt from October 2009. Bread was identified as the most appropriate food vehicle to maximise iodine intake because it is a widely-consumed staple food in Australia. However, iodine supplementation will still be required for those who do not consume fortified bread, as well as women who are pregnant, breastfeeding or considering becoming pregnant, to meet their increased needs. Salt in General Sodium and chloride are essential to good health and both play a crucial role in the body. Both sodium and chloride swim in our bodily fluids – which is why our tears, blood and sweat taste of salt. Sodium and chloride are electrolytes – meaning they are special minerals that have an electrical charge. Electrolytes are required for regulating nerve and muscle activity and other physiological functions. Sodium is needed to maintain proper fluid balance, it also helps the muscles to contract, nerves to transmit messages and cells to take up nutrients. Chloride is involved in food digestion and is needed to maintain the body’s acid-base balance. Research Update A recent survey showed that the Australian population (aged 2 years and older) consumes an average of 5.5 grams of salt per day.9 Although recent media reports suggest that Australians regularly consume more than 40g of salt a day. These findings may be exaggerated as salt intake is poorly measured due to the variation of the sodium content in most foods. What’s more, the terms, “salt” and “sodium” are used interchangeably, but technically this is not correct as “salt” is sodium chloride. Recomm ended daily intake of salt For Adults The National Health and Medical Research Council (NHMRC) recommends that Australian adults (including pregnant and lactating women) consume less than 2,300 milligrams of ‘sodium’ per day. This is equivalent to about 6,000 milligrams (6 grams) or one-and-half teaspoons of ‘salt’ per day. For Children The recommended intake of sodium (milligrams per day) • • • • 1-3 years = 1,000 (3g salt). 4-8 years = 1,400 (4g salt). 9-13 = 2,000 (5.5g salt). 14 years and over = 2,300 (6g salt). Salt: The Hidd en Factor Amount of sodium (per 100 grams): About 75% of salt in the Australian diet comes mostly from processed foods; namely bread, processed meat, poultry, cereal products, biscuits, savoury sauces and condiment and cheese.10 According to Food Standards Australia, which monitors the salt levels in Australian food, the food industry had been successful in reducing salt in the last couple of years, but there remains potential for further improvement.11 • • • • Muesli (fruit) bar – 84mg Cereal – 250–850mg Bread (1 slice) – 450mg Processed meats – bacon – 2000mg, ham – 1600mg and salami – 1500mg Consumers concerned about their sodium intake should check the label for the amount of sodium per 100 grams. A ‘low sodium’ product is less than 120 milligrams per 100 grams. Other claims that assist with choosing products lower in sodium include reduced salt/sodium, salt/sodium free and no added salt/sodium. Table 3 12 Typical Meal Plan Sodium (Mg) Ideal Meal Plan Sodium (Mg) 368 ¹∕³ cup rolled oats with milk + 1 sliced banana 131 Tuna and avocado salad sandwich 432 902 Ravioli with chicken and mushrooms (350g) + 1 side garden salad (no dressing, sprinkled with salt) 869 Miso soup 632 Low fat yoghurt 200 Muesli bar, choc chip (35g) 63 Apple 1 ½ cup dry roasted, salted mixed nuts 458 ½ cup dry roasted, un-salted mixed nuts 16 Breakfast 1 cup breakfast cereal with milk Lunch Fried rice (350g) 1,750 Dinner Pizza (2 slices) + 1 slice garlic bread with butter Snacks Total 4,173 Why Do We Need Salt? • Maintain fluid balance. • Regulate blood volume and blood pressure. • Help our nervous system transmit messages. • Replace salt lost via sweat. • Assist with muscle contraction. • Assist with food digestion. • Preserve the acid-base balance in the body. 1,649 7 Healthy Tips – Take Control Other uses of salt • • • • When adding salt to your cooking or at the table, opt for the green packet. Control your salt intake by seasoning your own food. Check food labels for salt (sodium) levels and choose the lower salt options. Choose low salt foods (<120mg/100g) where possible and avoid high salt (>500mg/100g) foods. • See Table 3 for your ideal meal plan. • Add salt during the cooking phase to ensure all the family enjoys equal salt levels. Too much or too litt le Did You Know? Encasing meat in a crust of salt will draw out and adsorb the fat, while sealing in moisture and flavour. The salt casing also reduces cooking time. As a rule of thumb, the body simply excretes any excess salt consumed. However, an increased level of sodium in our bodies can increase the risk of hypertension (high blood pressure), which is a risk factor for heart disease, including strokes and heart attacks. The kidneys regulate the amount of sodium the body needs by excreting excess amounts. When the kidneys can’t excrete enough sodium, excess sodium starts to accumulate in the body, increasing in the blood volume. The heart then needs to work harder to maintain normal circulation; resulting in high blood pressure. According to the 2007-2008 National Health Survey, 16% of the Australian population reported one or more long term conditions of the cardiovascular system, ranging from heart attack, stroke, varicose veins and high blood pressure. The most common of these conditions was high blood pressure, (reported by 9% of the population).13 Many of us consider salt as a food item, however it has many uses: • Steriliser. • Food scrub. • Body scrub. Did you know it can also be used to: • Check egg freshness: Put your ageing egg into salted water. If it floats it’s still fresh enough to eat. If it sinks, throw it out! • Defrost snow: Sprinkling salt on icy roads or paths to lower the melting point of water so it melts quicker. • Drilling: Salt is mixed with boring mud, which is pumped down bore holds to form a wall, when drilling through gravel or sandy material which will not stand up on its own. • Fish and meat curing: Usually carried out by dissolving salt to form a strong brine to act as a pickle, inhibiting the growth of bacteria. The products may be placed in the pickle, or in many cases the pickle is pumped into the actual meat (such is the case in bacon and ham), preserving the fish or meat. • Pottery glazing agent: Salt is used to form the very smooth glaze on clay tiles or pottery ware. After a kiln of tiles reaches a yellow to white heat, salt is then fed on the fire. The salt vaporizes and passes onto the surface of the tile, actually form a glass surface. • Textile dying: Salt is added to the dye baths during the process mainly to make the dyes fast. On the contrary, not enough sodium can lead to hyponatremia – a condition that occurs when the sodium in your blood falls below the normal range. This condition is rarely seen, however, except among ultra-endurance athletes competing in hot climates. The salt lost through sweat interferes with the body’s ability to regulate fluid and in severe cases can lead to muscle cramps, nausea, vomiting and dizziness. Do we nee d extra salt in hot weather? Only a small amount of salt is lost through sweat, even in extremely hot climates. So there’s no need to eat more salt in very hot weather. Although it is very important to drink plenty of water to keep the body hydrated. 1 2 3 4 Professor Creswell Eastman. Iodine Deficiency. Medical Observer. 15 May 2009. NUTTAB 2006 food composition table. Food Standards New Zealand Australia Professor Creswell Eastman. Iodine Deficiency. Medical Observer. 15 May 2009. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. Canberra: Department of Health and Ageing, Commonwealth of Australia; 2006. 5 6 7 8 Iodne-deficiency disorders. M Zimmerman.The Lancet. Vol 372: October 2 (2008). http://www.foodstandards.gov. au/monitoringandsurveillance/ australiantotaldiets1914.cfm SAXA brand Tracking Study – AC Neilson Based on the 2008 iodine deficiency global score card produced by the International Council for Control of Iodine Deficiency Disorders (ICCIDD).. http://www.iccidd.org/media/ IodineNetworkScorecard2008.pdf 9 10 11 12 13 http://www.foodstandards. gov.au/newsroom/ factsheets/factsheets2009/ howmuchsodiumandsalt4340.cfm FSANZ 2009 How much sodium are we eating? http://www. foodstandards.gov.au/ www.ausfoodnews.com.au. Australian salt intake too high but manufacturers making progress in salt reduction. May 22, 2009 Recommended daily intake of sodium is less than 2,300mg Australian Bureau of Statistics: 2007-08 National Health Survey 9 Salt Scrub • ½ cup oil – sweet almond, grape seed or rice bran oil are all good choices. • 1 cup Saxa fine sea salt. • 5 drops essential oils – the oil you choose for your body scrub depends on the result you want. Rose, lavender is relaxing, lemongrass refreshing and rosemary is stimulating. • Zest of ½ lemon or lime (optional). Combine the oil and salt in a bowl and mix well. Add essential oil and zest. To use, apply to dry skin using circular strokes to exfoliate the skin. Sit on the side of the tub to keep the scrub from making a mess. Don’t use a salt scrub if you have any cuts on your skin. Shower off or follow with a warm bath.