Salt substitute leads to fewer strokes and heart attacks

A reduced-sodium, potassium-rich ‘salt substitute’ reduces rates of stroke, heart attack and death, according to a new study published in The New England Journal of Medicine.

Researchers from the George Institute for Global Health showed that a salt substitute with more potassium chloride and less sodium chloride – the ‘normal’ table salt – leads to lower blood pressure and reduced heart problems, with no harmful effects.

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“Almost everyone in the world eats more salt than they should,’’ says lead author Bruce Neal. “Switching to a salt substitute is something that everyone could do if salt substitutes were on the supermarket shelves.

“Better still, while salt substitutes are a bit more expensive than regular salt, they’re still very low-cost – just a few dollars a year to make the switch.

“As well as showing clear benefits for important health outcomes, our study also allays concerns about possible risks.  We saw no indication of any harm from the added potassium in the salt substitute. Certainly, patients with serious kidney disease should not use salt substitutes, but they need to keep away from regular salt as well.” 

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The study was conducted with 21,000 adults with a history of stroke or blood-pressure issues from 600 rural Chinese villages in 2014/15. For those using the low-sodium salt, the team found that incidents of stroke dropped by 14%, total cardiovascular events (including heart attack) dropped by 13% and premature deaths dropped by 12%.

A table with a teaspoon with salt in it, a bowl of salt, salt crystals, and a salt shaker
Credit: Aleksandr Zubkov / Getty Images

They also showed that the price difference between table salt and the substitute was low – $1.48 per kilogram for regular salt compared to $2.22 per kilogram for low-sodium salt.

‘’Last year, a modelling study done for China suggested that about 400,000 premature deaths might be prevented each year by national uptake of salt substitute,” says Neal. “Our results now confirm this. If salt was switched for salt substitute worldwide, there would be several million premature deaths prevented every year.  

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“This is quite simply the single-most worthwhile piece of research I’ve ever been involved with.  Switching table salt to salt substitute is a highly feasible and low-cost opportunity to have a massive global health benefit.”

Because of this result, the researchers have urged salt manufactures to switch to low-sodium salt, and for governments to make policies that promote salt substitutes.

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