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According to research, dietary salt substitutes can help lower the risk of heart attack, stroke, and death from cardiovascular disease.
In a meta-analysis, researchers found salt substitutes were able to lower blood pressure in all participants regardless of geography, age, sex, history of high blood pressure, or weight.
For each 10% lower proportion of sodium chloride in salt substitutes, systolic blood pressure dropped 1.53 mmHg and diastolic blood pressure dropped 0.95 mmHg.
After recent research found adding table salt to food may lead to a shorter life expectancy, researchers have been looking for more answers to help keep our tickers in tip-top shape. A new meta-analysis found that swapping salt substitutes into our diet to help limit sodium can have major heart health benefits—no matter where in the world you are.
The meta-analysis published in the British medical journal, Heart found that dietary salt substitutes can lower the risk of heart attack, stroke, and death from cardiovascular disease anywhere in the world. This research was inspired by a recently published Salt Substitute and Stroke Study (SSaSS) from China, which found salt substitutes were able to decrease the risk of heart attacks, stroke, and early death. But scientists wondered if this result could be considered a worldwide result, or tied to China specifically.
To test this, researchers used the SSaSS study and additional clinical trials published up to August 2021 to determine the effects of salt substitutes on heart health on a worldwide scale. For this analysis, they used data from 21 relevant studies that spanned nearly 32,000 people from Europe, the Western Pacific Region, the Americas, and South-East Asia.
The final data found that salt substitutes were able to lower blood pressure in all participants regardless of geography, age, sex, history of high blood pressure, weight, baseline blood pressure, or baseline levels of urinary sodium and potassium. Overall, the reduction in systolic blood pressure (the higher number that represents the force at which the heart pumps blood around the body) was 4.61 mmHg, and the reduction in diastolic blood pressure (the lower number that represents the arterial pressure when the heart is filling with blood) was 1.61 mmHg.
In the studies used, the salt substitutes contained sodium chloride and potassium chloride. The proportions of sodium chloride in the salt substitutes varied from 33% to 75% and potassium ranged from 25% and 65%. For each 10% lower proportion of sodium chloride in the salt substitute, systolic blood pressure dropped 1.53 mmHg and diastolic blood pressure dropped 0.95 mmHg.
Additionally, data pulled from five of these trials that included more than 24,000 participants found that salt substitutes lowered the risk of early death from any cause by 11%, from cardiovascular disease by 13%, and the risk of heart attack or stroke by 11%.
What are salt substitutes?
Salt substitutes are an option people can use to help lower blood pressure. Many salt substitutes (and the one used in this study), called lite-salt, swap a portion of the sodium chloride (typical salt) with potassium chloride (the mineral potassium) because they taste similar but have a different nutritional profile, says Evelina Grayver, M.D., F.A.C.C., director of women’s heart program at the Katz Institute for Women. She notes most of these potassium salts have up to 70% less sodium than standard table salt and can help improve blood pressure. Other salt substitutes include:
Dr. Grayver explains that though MSG has had a bad reputation over the years, the product simply combines sodium with glutamate, which is an amino acid found in foods like mushrooms, tomatoes, and parmesan cheese. She says that most scientists have found it is totally safe to consume, but some people can have a strong reaction to it and experience unpleasant, short-term symptoms.
This seasoning has a nutty, cheesy flavor that has become popular recently among vegans. Nutritional yeast is made from deactivated brewing and baking yeast and is often fortified with B vitamins, Dr. Grayver says. It’s not sold as a salt substitute, but it has a savory flavor that can help amp up the flavor in many dishes.
This liquid seasoning looks similar to soy sauce and is made by treating soybeans with an acidic solution to break them into amino acids, Dr. Grayver says. It can also be made by fermenting coconut sap with water for a soy-free version.
Pink Himalayan salt
Though still a sodium product, pink Himalayan salt can provide a natural alternative to table salt because it’s minimally processed and harvested by hand in Pakistan, Dr. Grayver says.
What is sodium and potassium’s role in heart health?
Sodium is an essential mineral used for proper nerve and muscle function, Dr. Grayver explains. If we have too much sodium in our bloodstream, water is pulled into the blood vessels, increasing the volume and pressure, she says. This high blood pressure over long periods of time can stretch out or injure blood vessels, making it easier for plaque to accumulate, block blood flow, and make your heart work harder to do its job.
The American Heart Association (AHA) recommends consuming a maximum of 2,300 milligrams of salt per day and ideally no more than 1,500 mg for people with high blood pressure. The average sodium intake for Americans is closer to 3,400 mg per day, according to the AHA.
“To clarify, one teaspoon of table salt contains 2,325 milligrams of sodium, which will automatically push you over the AHA’s recommended intake,” Dr. Grayver says.
To combat this, they recently updated their guidelines to suggest choosing and preparing foods with little or no salt at all and the Food and Drug Administration (FDA) issued voluntary guidelines to reduce salt intake within the food industry.
So, what does potassium have to do with this? “Potassium has a different function in our body than sodium,” explains Keri Gans, M.S., R.D.N., C.D.N., nutrition consultant and author of The Small Change Diet. “Both sodium and potassium work together to help our body maintain fluid volume. Sodium maintains the fluid outside of our body’s cells and potassium maintains the fluid inside our cells.”
Potassium has long been linked with heart health and recent research suggests potassium-rich foods may boost women’s heart health. Gans adds, “Potassium helps our body excrete sodium through our urine and relax the walls of our blood vessels, both of which help lower blood pressure.”
How to lower sodium in your diet
Salt substitutes are a great option for those looking to swap out some salt. But, because salt substitutes are higher in potassium, Gans warns to be aware if you have kidney disease or are on medications such as ACE inhibitors or potassium-sparing diuretics. Too much potassium may be harmful to your body. Despite this, the researchers in this meta-analysis noted that no adverse effects were detected in participants from the increased potassium intake.
Additionally, George Fernaine, M.D., chief of cardiology at NYU Langone Hospital, says that though the meta-analysis is interesting, he doesn’t feel it’s enough to make a strong recommendation to start using salt substitutes to treat high blood pressure. “The treatment for high blood pressure is still exercise, weight loss, low/no salt diet, and blood pressure medication if deemed appropriate by your physician,” he says
To help lower sodium in your diet (in addition to any prescribed medication), Gans suggests turning to herbs and spices, such as rosemary, onion powder, thyme, celery seed, garlic, ginger, and parsley, or even acidic ingredients like lemon juice or balsamic vinegar for extra flavor when cooking with less salt. Additionally, ingredients like black pepper and nutritional yeast can add a lot to a meal, she says.
“Salt consumption is just a piece of heart health,” Gans says. She recommends a well-balanced, low-sodium diet, such as the Dietary Approach to Stop Hypertension (DASH) diet, getting regular exercise, scheduling adequate sleep, and maintaining a healthy body weight. For additional assistance, Gans says a registered dietitian can help guide your food choices when planning a lower sodium diet.
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