A study published in the Journal of the American College of Cardiology suggests that replacing regular salt with a salt substitute may reduce the risk of developing high blood pressure (hypertension) in older adults with normal blood pressure, without increasing the likelihood of low blood pressure episodes, explains a studypublished in the Journal of the American College of Cardiology.
The research, conducted on a group of participants who initially had normal blood pressure, revealed that those who used a salt substitute had a 40 percent lower chance of developing high blood pressure compared to those who used regular salt.
Considering that nearly half of U.S. adults suffer from hypertension, this finding holds significant implications for public health, as hypertension increases the risk of heart attack, stroke, and other cardiovascular conditions.
The study emphasized that while reducing sodium intake in known to lower blood pressure, there has been limited evidence regarding the effectiveness of salt substitutes in preventing hypertension in individuals with normal blood pressure.
Participants in the study were required to have a blood pressure reading below 140/90 mmHg and were not taking any blood pressure medications.
Around half of U.S. adults (over 122 million) have hypertension, which makes the heart work harder than usual. When left untreated, the risk of heart attack, stroke, and other health condition increase, says the American Heart Association.
Lead author Yangfeng Wu, MD, PhD, executive director of the Peking University Clinical Research Institute in Beijing, China, said in a press release, “It’s crucial to recognize the impact of our dietary choices on heart health and increase the public’s awareness of lower-sodium options.”
As per Dr. Wu, the findings show that replacing regular salt with a salt substitute offers a safe and effective way for people with normal blood pressure to lower cardiovascular risks without sacrificing flavor.
At Start of Study, All Participants Had Normal Blood Pressure
The authors note a lack of substantial evidence regarding the impact of salt substitutes on the future risk of hypertension in individuals with normal blood pressure, despite the established link between sodium reduction and blood pressure regulation. Participants in the study were required to have a blood pressure reading below 140/90 mmHg and were not taking any blood pressure medications.
Systolic blood pressure, the top number in a blood pressure reading, measures the pressure on blood vessels when the heart contracts, while diastolic pressure, the bottom number, measures the pressure when the heart muscle relaxes.
Normal blood pressure is defined as less than 120/80 mmHg, while high blood pressure, depending on the healthcare provider, is consistently identified as higher than either 130/80 or 140/90 mmHg.
Salt Substitute Reduces Hypertension Risk by 40%
The trial involved approximately 600 participants aged 55 years or older from 48 care facilities, divided into two groups. Half of the facilities and participants replaced regular salt with a salt substitute, while the other half continued using regular salt. The salt substitute used in the study contained a mixture of sodium chloride (62.5 percent), potassium chloride (25 percent), and dried flavoring ingredients (12.5 percent).
After two years, the incidence of hypertension was significantly lower in the group using the salt substitute compared to the group using regular salt.
Importantly, the study found that the use of salt substitutes did not lead to episodes of low blood pressure, a common concern among older adults, said the authors.
“I think the findings of the study are important to amplify,” says Diane Stadler, PhD, RD, a professor of medicine and director of graduate programs in Human Nutrition at Oregon Health and Science University in Portland.
“They demonstrate that even individuals with normal blood pressure can lower their blood pressure by using salt substitutes and can do so without the risks of becoming hypotensive, a condition which can cause light headedness, dizziness, fainting, and falls,” says Dr. Stadler, who was not involved in the study.
Hypotension, or low blood pressure, can increase the risk of falls and fractures, highlighting the importance of maintaining blood pressure within a healthy range.
Dr. Wu suggests that the findings indicate salt substitutes could serve as an effective strategy to reduce the risk of hypertension and heart disease for individuals, regardless of whether they already have hypertension.
Excessive Sodium Consumption Common Among Most Americans
“Adults frequently fall into the trap of consuming excess salt through easily accessible and budget-friendly processed foods,” said Dr. Wu.
According to the U.S. Food and Drug Administration (FDA), the average American consumes approximately 3,400 milligrams of sodium per day, which is nearly 50 percent higher than the recommended daily intake of 2,300 milligrams.
Furthermore, as Dr. Wu correctly points out, the majority of this excess sodium doesn’t stem from over-salting home-cooked meals. Instead, over 70 percent of our dietary sodium originates from packaged and prepared foods like deli meat, pizza, tacos, and chips.
What Health Risks Are Associated with Reducing Salt Intake or Utilizing a Salt Substitute?
Elisabetta Politi, MPH, RD, a certified diabetes educator at Duke Health in Durham, North Carolina, advises individuals interested in using a salt substitute to lower their sodium intake to consult with their healthcare provider beforehand.
“Salt substitutes can raise blood potassium levels to unsafe levels in people with conditions such as kidney disease, heart disease, liver disease, and diabetes. Individuals taking certain blood pressure-lowering medications, including angiotensin-converting enzyme (ACE) inhibitors and potassium-sparing diuretics, also may be at risk of elevated potassium in their blood,” she says.
Another aspect to consider when reducing salt intake, using salt substitutes, or opting for non-iodized salt is their impact on total iodine intake, explains Stadler. Iodine is vital mineral necessary for maintaining thyroid function.
“Table salt is iodized to prevent iodine deficiency, a condition associated with the development of goiter. Iodine deficiency was a public health concern in the early 1900s but was pretty much eradicated with the ionization of salt,” she says.
Stadler further notes that iodine deficiency can still occur if individuals do not consume enough iodine-rich foods, such as fish, shellfish, seaweed, and cow’s milk. Additionally, milk serves as a source of iodine due to the use of iodine wash as an antimicrobial agent in the milking process.
Upon receiving approval from a healthcare provider, Dr. Politi suggests cautiously introducing a blend salt substitutes to monitor its effects on blood pressure.
Is It Possible to Substitute Salt in Baking and Cooking as You Would with Table Salt?
Salt substitutes come in various types, some containing both potassium chloride and sodium chloride, while others solely comprising potassium chloride, as indicated under the “ingredients” section on the label.
Some individuals find potassium chloride alone as palatable as sodium chloride; it depends on your tastebuds, says Dr. Politi. “I suggest experimenting with different products, using moderation as an important guideline,” she says.
According to Dr. Politi, you can incorporate salt substitutes into cooking and baking, but the quantity required may differ. For instant, Nu Salt advises beginning with small quantities and adjusting according to taste. For detailed instructions, refer to the product label or visit the manufacturer’s website.
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