Salt can almost feel like cheating in the kitchen. Salt can instantly improve the flavor of any savory dish by adding just the right amount of salt, but it has a downside.
Simply put, salt is bad for your health. To be more specific, excess sodium can cause problems. Sodium is the primary element that makes up salt (aka sodium chloride).
Research has been done extensively in the past to examine the link between excessive sodium intake and increased risk of developing cardiovascular disease.
Other studies also show that insufficient potassium intake can have a negative impact on blood pressure.
It turns out that one product, which is often found in supermarkets, can solve both of these problems simultaneously: salt substitutes. These products are made to taste exactly like salt but have lower sodium levels and more potassium.
However, salt substitutes are promising, but there have not been large clinical trials that measured their effect on stroke, heart disease and death. So, questions remain about whether they are effective.
A huge study in China suggests that everyone would be better off switching.
Bruce Neal, a clinical epidemiologist at the George Institute for Global Health in Australia, says that "almost everyone" eats more salt than is necessary.
"If salt were replaced with a salt substitute around the world, many million premature deaths would be prevented each year."
Neal and his colleagues examined more than 20,000 rural Chinese villagers. They recruited participants who had suffered from strokes or low blood pressure. They were from 600 villages, and the average age was 65.
Half of the participants received a salt substitute free of charge for the duration of the experiment. This was a five year experiment that was slightly affected by the COVID-19 pandemic.
They were advised to use the salt substitute with less sodium and more potassium. This was to maximize their sodium reduction.
The other half of the village acted as a control group and used salt in their food preparation and cooking as always.
The health outcomes of both these groups were markedly different at the end of the study.
Over 4,000 participants died in the five-year period since the experiment began. More than 3,000 had suffered a stroke and more than 5,000 had some type of major cardiovascular event. These are not surprising given their age and the health of the participants at the beginning of the trial.
The results showed that salt substitutes were significantly less likely than regular salt consumers to suffer strokes (29.14 events vs.33.65 events per 1,000 individual-years), as was lower risk of major cardiovascular events (49.09 vs. 56.29 Events), and death (39.28 vs. 44.61 Events).
According to the researchers, their findings confirm the previous modeling in China that suggested salt substitutions at a national level could save lives of approximately 460,000 people each year by preventing premature deaths from excessive sodium intake.
The researchers extend and this part of the hypothesis suggests that the same simple substitution could save millions of lives each year if everyone worldwide switched from regular salt to the healthier, slightly modified alternative.
These protective effects may be hindered by the differences in how food is made across countries.
"In rural China, processed food is not used. Rather, dietary sodium chloride (dietary sodium) is added to each household's food preparation." Julie R. Ingelfinger, pediatrician at Massachusetts General Hospital, explained in a commentary.
"In contrast, much of the world's commercial food preservation adds a lot of sodium chloride to the diet. The use of salt substitutes wouldn't fully account for the majority salt intake."
One solution could be to substitute salt in the home kitchen for salt in the industrial kitchen where processed foods are made.
Researchers say that the cost of salt substitute is not much different than regular salt. However, considering how inexpensive regular salt is (around US$1.08 per kilogram in China) and how little salt is needed for cooking, it is quite affordable, especially when you consider the benefits.
Neal states that salt substitutes can be a little more expensive than regular salt but they are still very affordable at just a few dollars per year.
"This is the most valuable piece of research that I have ever been involved in."
The NEJM reports the findings.
