- Chinese researchers say that using a salt substitute can help improve heart health.
- But experts say the study’s results don’t necessarily apply to the United States because of the different diets and higher consumption of processed foods.
- They suggest including more fruits and vegetables as a way to reduce sodium intake without using salt substitutes.
Switching from table salt to salt substitutes may help reduce the risk of stroke in people over age 60 with a history of high blood pressure or stroke.
That’s according to a study published this week in the New England Journal of Medicine.
The research included nearly 21,000 participants and took place in 600 villages in rural areas of five Chinese provinces.
About 72 percent of study participants had a history of stroke and 88 percent had a history of high blood pressure.
Participants were given free salt substitutes (about 75 percent sodium chloride and 25 percent potassium chloride) as a replacement for common salt and were advised to use it for cooking, seasoning and food preservation.
They were also encouraged to use the salt substitute more sparingly than before to maximize their sodium reduction.
Sufficient salt substitute was provided to cover the needs of the entire household (approximately 20 grams per person per day).
Participants from other villages continued with their usual cooking and eating habits.
The project was supported by the National Council for Health and Medical Research.
“This study provides clear evidence of an intervention that could be undertaken very quickly at very low cost… We have now shown that it is effective and that is the benefit for China alone. Salt substitution could be used by billions more with even greater benefits, ”said Dr. Bruce Neal, principal investigator of the study and professor at the George Institute for Global Health in Sydney, Australia, in a report. Press release.
A big question arising from this research is whether it is applicable in the United States and other countries outside of China.
“While I wish I could say yes, it’s more realistic to probably say no,” said Dr. Elizabeth Klodas, FAAC, a Minneapolis-based cardiologist and founder of Step One Foods.
Klodas noted that since the study looked at high-risk populations, the results may not apply to other populations (for example, people without high blood pressure and without stroke).
“This was also a study of a unique genetic / cultural group with specific eating habits / patterns and may not translate to other populations,” Klodas told Healthline.
The biggest obstacle to reducing sodium intake in the United States is that much of our sodium intake is not under our control.
“In rural China, most meals are cooked from scratch, so sodium intake is under the control of the preparer. Americans eat a lot more prepared and processed foods – and a lot of these products have a lot of sodium before we even get in the salt shaker, ”Klodas explained.
Sodium can also lurk almost anywhere, she said.
A plain bagel, for example, can provide 450 milligrams of sodium, before you even put anything in it. The maximum recommended sodium intake is 2,300 milligrams per day, so one bagel is about 20 percent of a full day’s sodium allowance.
“The salt substitute won’t help you much there,” Klodas said.
“Finally, the intake of base salt was very high (assumed to be up to 20 grams of salt per person per day), so the observed effect might not translate to those consuming less salt to begin with,” she added.
Kimberly Gomer, MS, RD, LDN, director of nutrition at the Pritikin Longevity Center, explained that in theory, a salt substitute would improve cardiovascular risk because it would definitely improve high blood pressure, and it comes at a price.
“Potassium chloride as a substitute is a problem. As we age, our kidney function naturally slows down. We measure kidney function by glomerular filtration rate, or GFR.
“Our kidneys are our filtering device. So the natural aging process will slow down GFR, and putting potassium directly on food as a seasoning will negatively affect that, ”Gomer told Healthline.
Ultimately, Klodas said, the answer isn’t how to manipulate the sodium content of what we usually eat, but rather how to change what we eat.
“We never recommend these salt substitutes, but rather beautiful herbs, both dried and fresh, to enhance the taste of food,” Gomer said.
She explained that such a change is an adjustment of the palate.
Because we are used to heavily salty foods and using salt and other high salt seasonings, such as soy sauce, teriyaki and all the various black and Himalayan salts which are now popular, this may take weeks or months to make this adjustment.
“A simple way to reduce sodium in our diets is to deliberately add foods that are naturally sodium-free, including all fresh fruits and vegetables,” Klodas said. “It helps to naturally displace items with higher sodium content. “
She explained that eating fruit before lunch or dinner, for example, can be a way to reduce sodium intake while increasing intake of several beneficial nutrients, including potassium.
“Adding fresh or frozen fruits and vegetables while reducing sodium intake has been shown to be as effective as adding medication to lower blood pressure,” Klodas said.
While it takes some time to make the switch and see the benefits, Gomer said the positives are clear.
“Less bloating, decreased water retention, easier weight loss due to lack of salt stimulation and, more importantly, (rapid) reduction in blood pressure in those who are salt sensitive”, she noted.