Study Highlights Health Benefits of Salt Substitutes in Reducing Cardiovascular Risks

It is common knowledge that excessive sodium intake is associated with cardiovascular disease and mortality. However, many people continue to consume unhealthy amounts of salt—sodium chloride—in their foods. Scientists say that one strategy for satisfying one’s taste for salty foods while reducing health risks is the use of salt substitutes.A new study published in the Annals of Internal Medicine found that the use of salt substitutes can result in a lower incidence of cardiovascular disease and a reduced risk of death from any cause for up to 10 years. 

Salt substitutes typically contain lower amounts of sodium and increased potassium levels. 

The study analyzes the results of 16 randomized controlled trials (RCTs). Eight of these reported incidences of major cardiovascular events and all-cause mortality for six months or greater. Seven of the eight RCTs were conducted in China and Taiwan. After six months, the remaining RCTs tracked hypertension, cause-specific mortality, and effective urinary excretion. 

Even though salt substitutes benefit Western populations, current research evidence cannot confirm this since data is unavailable. In the research population, salt consumption tends to be discretionary. It is primarily driven by salt added to food, which is only partially from added table salt, but also soy sauce and other condiments. 

Within the study population, food preparation more often occurs in the home, where adding sodium is a conscious choice. In Western populations, salt consumption is more driven by processed, packaged, and takeaway/restaurant food. Not only do many Western processed foods inherently contain salt, but they often contain salt as a preservative and a flavor enhancer. This includes meats, etc., that are pre-seasoned at supermarkets. Snack foods also typically contain high amounts of sodium. 

Potassium is essential for the balance of the heart’s electrical system, including heart muscle contraction and relaxation. It plays a role in the interplay of sodium and potassium in regulating blood pressure. Researchers noted that one can ingest too much potassium, leading to hyperkalemia, making a healthy balance between potassium and sodium a balancing act.This is difficult to quantify as our study did not examine whether the decreased sodium alone is driving the effect or whether the increased potassium has additional benefits. 

Another study looking at salt substitution and sodium restriction found reductions in cardiovascular risk for salt substitution but not salt restriction, pointing towards the benefit of increased potassium intake. Many factors other than sodium intake contribute to cardiovascular health, including smoking, diet, and exercise. There are also many other ways to reduce sodium intake, such as going for whole/unprocessed home-prepared food over processed or takeaway food. Using a salt substitute is an excellent option for someone looking for an easy way to reduce their sodium intake without breaking the habit of adding salt to their food. 

Journal Reference – Greenwood, H., Barnes, K., Clark, J., Ball, L., & Albarqouni, L. (2024). Annals of Internal Medicine. doi:10.7326/m23-2626