Should You Be Using a Salt Substitute? New Study Suggests Low-Sodium Salts May Lower Risk of Stroke

For most of us, salt is a vital component of making food taste great. In her best-selling book Salt, Fat, Acid, Heat, renowned chef Samin Nosrat explains that salt is a necessary mineral for the human body, helping with biological functions like maintaining the right blood pressure and water distribution, delivering nutrients between cells, nerve transmission, and muscle movement. “We’re hardwired to crave salt to ensure we get enough of it,” she writes.

Yet, salt can be tricky for many people. The Dietary Guidelines for Americans 2020-2025 recommends consuming less than 2,300 milligrams of sodium per day, but the Centers for Disease Control and Prevention (CDC) claims that most people in the U.S. consume more salt than necessary. When your body has an excess of salt, it can mess with some of the very biological functions it usually helps—namely: blood pressure. If your doctor determines you have high blood pressure, they’ll typically ask you to watch how much salt you eat. Excess salt can also increase the risk of heart disease and stroke, the CDC says.

A recent sodium study published in the New England Journal of Medicine suggests a solution for salt-lovers at risk: Use a salt substitute to keep the taste-boosting power but cut back on sodium.

Researchers recruited nearly 21,000 people in rural China, asking half of them to switch their usual salt with a salt substitute made up of 75 percent sodium chloride (aka regular table salt) and 25 percent potassium chloride. Importantly, everyone in the study either had a history of stroke or was 60+ years old and had high blood pressure. In order to properly test the effect of salt substitutes, the researchers had to use a population who were likely to have negative outcomes tied to excess sodium, like stroke and heart disease, says Bruce Neal, PhD, lead author of the study. They followed the group for almost five years and found that those who consistently used the salt substitute had significantly lower rates of stroke, major cardiac events, and death.

Before you get rid of your salt shaker, it’s important to take the results of this study with, well, a grain of salt. Because everyone in the study had a medical history that clearly indicated a need to cut back on sodium, it’s not totally clear how the results translate to the overall population, especially in a country as different as the U.S., says nutritionist Tori White, RD. “Our environment is different. [Some of] our genetic makeup is different. There are just so many variables,” she says. In fact, Dr. Neal expects that people in the U.S. wouldn’t see as large an effect as his team found in rural China. “In the U.S., a lot of your dietary sodium actually comes from processed and packaged foods,” he says. However, eating processed foods is exceedingly rare in the Chinese population they studied, making the salt shaker switch more powerful.

Although switching out cooking salt may not make a huge dent in our sodium levels, salt substitutes have another potential benefit: added potassium. Like the substitute used in the study, most salt substitutes are partially or fully made up of potassium chloride, which tastes similar to salt—though not exactly like salt.  And potassium helps with cell functioning as well as regulating blood pressure, the Mayo Clinic says. “Sodium and potassium have a cooperative relationship in the body and can kind of help even each other out,” White says. “So this is where the importance of balance really comes in.” She says that potassium is abundant in foods like bananas, oranges, tomatoes, and avocados, but many people don’t get enough potassium in their typical diet. There’s the possibility of salt substitutes being a win-win for some people: reducing your sodium a little bit and increasing your potassium.

As with any other health advice, whether or not you should consider a salt substitute depends highly on your personal health. If your doctor has told you that you have high blood pressure or asked you to eat less sodium, using a salt substitute can be an easy and helpful change to make. But there are risks with increased potassium, too. Too much potassium can be a big problem for people with kidney disease because the kidneys are responsible for flushing extra potassium out of your system, White says. When potassium builds up in your body, it can increase the risk of heart attack and arrhythmias, according to a study published by the American Heart Association. People who have kidney problems, people taking medications that already contain potassium or that prevent the kidneys from properly flushing potassium out, and people who have diabetes should likely avoid salt substitutes containing potassium. Whenever using a new dietary supplement, it’s important to consult your doctor first.

There are lots of salt substitutes

If it’s safe, and especially if your doctor has asked you to lower your sodium intake, you might want to consider a salt substitute. There are many available online and in grocery stores, some of which replace all of the sodium with potassium and some (like those used in the study) which only replace a percentage of regular salt with potassium chloride. Classic salt brand, Morton, makes a salt substitute. Morton’s salt substitute has 610 mg of potassium per quarter teaspoon. MySalt has no sodium, and it contains about half the potassium as other salt-free substitutes at 356 mg per quarter teaspoon. And, as the name suggests, NoSalt has no sodium.

Additionally, there are light-salt options. Zea’s salt substitute is 80 percent potassium chloride. LoSalt has 66 percent less sodium than regular table salt, making up the difference with potassium, magnesium, and iodine. You might know Lawry’s as a classic seasoned salt. Their sodium-light version cuts 25 percent of the sodium with potassium chloride but keeps all the other spices that make Lawry’s delicious.  Na Tivo has 60 percent less sodium than normal salt; it's made up of potassium chloride, with some magnesium carbonate added, too.

For those for whom potassium isn’t a safe alternative, or who don’t like the taste of the potassium substitutes, there are other ways to cut back on sodium but still make food taste great. Since processed and packaged foods make up such a large percentage of our dietary sodium in the U.S. (some studies estimate up to 75 percent), “a more careful approach to buying pre-packaged foods may be the best line of defense for maintaining health,” says nutritionist Cheyenne Richards, RDN. Cutting a few processed foods can be as simple as making your own salad dressing instead of buying the bottled kind, White suggests. “That way, you can have control over how much salt you add in,” she says. (Try this lemon, tahini, and herb dressing, or this 5-minute dressing with olive oil and lemon juice).

There are also ways to use less salt in your cooking

Give your food a boost of flavor with salt-free spice blends like Mrs. Dash and Flavor Mate, Richards suggests. If you don’t tend to use many spices in your cooking, you might find they provide the flavor you need to skip that extra pinch of salt. White even suggests trying nutritional yeast. Also known as “nooch,” nutritional yeast is an inactive yeast that tastes a bit cheesy and packs a big umami punch.

Try different sources of salt like anchovy paste, parmesan cheese, soy sauce, pickled vegetables, and miso paste, White suggests. All of these things are high in sodium, but they pack other types of flavor, like acid or umami, which may mean you need to use less than you would if you were reaching for straight-up salt.

Add some acid instead. In Salt, Fat, Acid, Heat, Nosrat explains that “acid is salt’s alter ego.” Both are important to properly season food. Instead of adding another pinch of salt, your dish might need a touch of vinegar or lemon juice. Learning to use acid to balance the flavors in your food may naturally lead to using less salt.

Use garlic and fresh herbs for added flavor, White suggests. Sometimes using less salt is as easy as adding other flavors. Things like garlic, shallots, and fresh herbs like cilantro, dill, or parsley are very flavorful and can make bland foods taste amazing without any additional salt.

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