Landmark study shows simple salt swap could prevent millions of deaths each year

https://medicalxpress.com ^ | August 30, 2021 | by George Institute for Global Health

[Red Badger]

Replacing table salt with a reduced-sodium, added-potassium 'salt substitute' significantly reduces rates of stroke, heart attack and death, according to the results of one of the largest dietary intervention studies ever conducted.

Presented at a 'hotline session' at the European Society of Cardiology Congress in Paris on August 29, and simultaneously published in the New England Journal of Medicine, the results also showed that there were no harmful effects from the salt substitute.

High levels of sodium intake and low levels of potassium intake are widespread, and both are linked to high blood pressure and greater risks of stroke, heart disease and premature death. Using a salt substitute—where part of the sodium chloride is replaced with potassium chloride—addresses both problems at once. Salt substitutes are known to lower blood pressure but their effects on heart disease, stroke, and death were unclear, until now.

Lead investigator, Professor Bruce Neal of The George Institute for Global Health, said that the scale of the benefit seen in the study could prevent millions of early deaths if salt substitutes were widely adopted.

"Almost everyone in the world eats more salt than they should. Switching to a salt substitute is something that everyone could do if salt substitutes were on the supermarket shelves,"' he said.

'"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," added Professor Neal.

The Salt Substitute and Stroke Study enrolled 21,000 adults with either a history of stroke or poorly controlled blood pressure from 600 villages in rural areas of five provinces in China—Hebei, Liaoning, Ningxia, Shanxi and Shaanxi between April 2014 and January 2015.

Participants in intervention villages were provided enough salt substitute to cover all household cooking and food preservation requirements—about 20g per person per day—free-of-charge. Those in the other villages continued using regular salt.

During an average follow up of almost five years, more than 3,000 people had a stroke. For those using the salt substitute, researchers found that stroke risk was reduced by 14 percent, total cardiovascular events (strokes and heart attacks combined) by 13 percent and premature death by 12 percent.

Professor Neal said that because salt substitutes are relatively cheap (about US$1.62 per kilo versus US$1.08 per kilo for regular salt in China) they are likely to be very cost effective too.

'"Last year, a modeling study done for China suggested that about 400,000 premature deaths might be prevented each year by national uptake of salt substitute. Our results now confirm this. If salt was switched for salt substitute worldwide, there would be several million premature deaths prevented every year," he said.

"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."

As a result of the study, George Institute researchers are calling for the following actions:

Salt manufacturers and retailers worldwide should switch to producing and marketing salt substitute at scale

Governments worldwide should design polices to promote salt substitute and discourage regular salt use

Consumers worldwide should cook, season and preserve foods with salt substitute not regular salt

Explore further:

Salt substitution—an effective way to reduce blood pressure in rural India

More information: Bruce Neal et al, Effect of Salt Substitution on Cardiovascular Events and Death, New England Journal of Medicine (2021). DOI: 10.1056/NEJMoa2105675

Journal information: New England Journal of Medicine

Provided by George Institute for Global Health

[qam1]

I take mega-doses of Vitamin D, so can I still use as much regular salt as I like.

I leaned on Freerepublic that Vitamin D prevents/cures everything so I don’t have to worry.

[Prince of Space]

OMG, I finally found my long lost twin! I rarely salt my food, and there’s not enough pepper in the world for me. It has to be fresh ground though, and preferably a medley of peppercorns, like green, white, etc.

[webheart]

Potassium and sodium are electrolytes. They work together to create nerve impulses. There is a necessary ratio of approximately 3 sodium atoms per one potassium atom. When sodium goes down too low, it’s called hyponatremia.

Too much potassium will kill you. That is called hyperkalemia. It is a component of euthanasia drugs and execution cocktails. Sodium is eliminated primarily through perspiration and peeing, potassium cannot be eliminated except through vomiting.

[poinq]

Nope, you need salt. Potassium is a matter of spinach a baked potato or a glass of milk. This study is based on people who have horrible diets and get salt from chips and other snacks. Don’t trade salt for anything. Just have one baked potato a week and your pretty fine.

[Honorary Serb]

.....Almost everyone in the world eats more salt than they should.....

Except for those of us who have low blood sodium!!!!

[M. Thatcher]

I've been using potassium NoSalt, available at grocery stores everywhere, for YEARS. I prefer it, WAY more flavor. I carry it in my purse.

[Gay State Conservative]

Funny....my cardiologist (a senior physician on the Harvard Medical School faculty) says it is.

[Openurmind]

Kidney patients... DO NOT DO THIS. The Potassium is even worse than the salt! Unless you live in the hot desert cut out BOTH to be healthier.

[Manuel OKelley]

If you do that and cut sugar and most processes /junk foods as well you can eat as much salt as you like with no issues.

[Seruzawa]

First off this study has a 50% chance of being fraudulent right out of the gate. Then we’ll see if it’s causation or the usual correlation that medicos are so in love with.

[BiglyCommentary]

The CREATOR’S SALT, I.E. SEA SALT is what was intended to go into the body. Sea salt that has been stripped of everything other than sodium chloride is what causes all these “salt” issues. Humans are not supposed to be consuming large amounts of a single chemical - sodium chloride.

[Nifster]

But how does it taste??

[Pollard]

We use Morton Lite Salt

50% less sodium and tastes like salt

[Nifster]

TOO much sodium. Reasonable amounts like regular sugar are not bad for you

[JCL3]

Be VERY careful buying into the “low sodium” and “drink more water” generalizations. Having not eaten the “SAD”(Standard American Diet”) in decades, following the “cut sodium” can lead to LOW sodium and chloride levels in blood work. If one sweats during exercise or working AND consumes a LOT of water, levels can result in an ER visit.

How did I learn this? Followed the “cut your salt” and “drink more water” mantra. Having blood work 4 times per year(2 at employer, 2 at PCP doc) caught it. I add salt to almost all meals and my sodium and chloride levels are “In Range” now.

[BiglyCommentary]

I love, love, love salt and have for decades but it is always sea salt, not the chemical sodium choride, what people call salt today. Salt underwent this bad transformation with the advent of modern food processing in the 20’s and 30’s. The Creator put those 15% of minerals in there for a reason. They are very important to how the body uses the sodium chloride component. MAN SCREWING WITH THAT FORMULA is the problem, not salt, real salt.

[SgtHooper]

That’s like sticking your food into a capsule and washing it down with water! No TASTE! Not me! I sweat! I apply salt!

[telescope115]

Right ! I was told just last week that my potassium level was borderline high, still recovering from surgery and kidneys are not quite 100%. The co-ordinater who called said to watch it with the raisins, bananas, tomatoes and other foods high in potassium. I love farm fresh tomatoes! Our neighbor has been giving us some from her garden and we have been in tomato heaven. NowI have to cut back?
@#$&@#$&@!!!I have been using a salt substitute, but I guess I’ll just have take my chances with kosher& sea salt, sparingly.

[telescope115]

It seems like no matter WHAT we eat, it’s wrong.🤨

[PIF]

Cough cough… soy sauce or tamari and salt ...