Low-sodium salt to improve health

Replacing salt with a low-sodium alternative lowers the risk of stroke, research has found. It was already understood that both high sodium and low potassium intakes are associated with an increased risk of cardiovascular disease and premature death, as well with high blood pressure, but research had not previously been conducted on the use of salt with potassium to increase health outcomes.

In a study conducted in 600 rural Chinese villages and with over 20,000 participants, researchers found that people who replaced sodium-based salt with a potassium-rich alternative, and those who reduced salt intake, had better health outcomes including a reduced likelihood of stroke or cardiovascular disease. The sodium alternative was a mix of 75% sodium chloride and 25% potassium chloride. The results show that significantly more people died of stroke and cardiovascular disease who had a sodium-rich diet than those who had used the sodium-reduced salt.

Principal investigator Professor Bruce Neal of the George Institute for Global Health, Sydney, Australia said, “This study provides clear evidence about an intervention that could be taken up very quickly at very low cost. A recent modelling study done for China projected that 365,000 strokes and 461,000 premature deaths could be avoided each year in China if salt substitute was proved to be effective. We have now shown that it is effective, and these are the benefits for China alone. Salt substitution could be used by billions more with even greater benefits.”

“The trial result is particularly exciting because salt substitution is one of the few practical ways of achieving changes in the salt people eat. Other salt reduction interventions have struggled to achieve large and sustained impact.”

“Importantly, salt substitute is very easy to manufacture and it is not expensive. A kilo of regular salt, which lasts for months, costs about US$1.08 in China. The price for a kilo of salt substitute is US$1.62 per kilogram. It is primarily lower-income and more disadvantaged populations that add large amounts of salt during food preparation and cooking. This means that salt substitute has the potential to reduce health inequities related to cardiovascular disease.”

The research was published here in the New England Journal of Medicine.

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