Potassium-based salt substitute lowers the risk of strokes and heart attacks

10 October 2021

Salt is made of sodium chloride, and the sodium directly raises blood pressure. Existing research has already shown that swapping regular salt for a low-sodium alternative can lower blood pressure. Now, a landmark new study conducted in China and published in the New England Journal of Medicine this August, has shown that potassium-based salt substitutes can help prevent the consequences of high blood pressure too, including stroke and premature death.

The Salt Substitute and Stroke Study (SSaSS) took place in 600 villages in rural China and included 20, 995 people who either had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were split into two groups. One group continued to use regular salt which is made of sodium chloride, and the other group used a salt substitute which is approximately 70% sodium chloride and 30% potassium chloride. 

The researchers recorded the rates of stroke, serious events caused by diseases of the heart and blood vessels, and death. They also recorded side effects caused by high levels of potassium in the blood.

After five years, those using the salt substitute had:

• 14% lower risk of stroke
• 13% fewer major adverse cardiovascular events (such as heart attacks)
• 12% fewer premature deaths
• No more adverse effects due to high potassium in the blood than the salt group.

The results have huge implications for public health. Using a potassium-based salt substitute instead of regular salt would be a simple and cost-effective way to lower blood pressure across populations and in turn prevent millions of premature deaths.

It’s important to note the safety of the potassium-based salt substitutes as there have been concerns among public health professionals that they could cause serious side effects, and this study does not support those concerns.

The authors 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 substitutes and discourage the use of regular salt.
  
  
• The public should cook, season and preserve foods with salt substitutes instead of regular salt.

 

Professor Feng He, Professor of Global Health Research at the Wolfson Institute of Population Health, Queen Mary University of London, says:

"This study provides the evidence that using a salt which contains less sodium and more potassium will effectively reduce salt intake and increase potassium, thereby reducing the risk of people suffering from strokes and death from any cause. Globally, millions of lives would be saved by this simple approach. Salt consumption in China is amongst the highest in the world, with average salt intakes (10-12g/day) more than double the WHO recommended limit (less than 5g/day). In China and most developing countries, the majority of salt in the diet is added by the consumer, therefore encouraging people to use less during cooking is the best strategy to improve public health." 

Graham MacGregor, Chairman of Blood Pressure UK and Professor of Cardiovascular Medicine at Barts and the London School of Medicine, said: “This very important study clearly demonstrates that for the UK and other developed countries:

• Consumers should be encouraged not to add salt to food, but if they have to, it’s vital that they use a reduced sodium with added potassium salt.
• The food industry can reduce the huge amounts of salt they add to food, and safely replace it where necessary with potassium salt.

“In the UK, in spite of a previous very successful programme to get industry to reduce the amount of salt they add to food, this policy has been stalled by lack of government action in forcing the industry to reduce salt further. The Department of Health and Social Care, which has taken over Public Health England’s responsibility in this area, needs to urgently act to get the food industry to reduce the amount of salt they add to food and save the maximum number of people dying unnecessarily from stroke.”

Caroline Klinge, Marketing Director for LoSalt®, comments: “At LoSalt®, we have long been flying the flag for salt awareness, the implications of having high blood pressure and how using a reduced sodium salt can benefit. With hypertension projected to affect 1.5 billion people globally by 2025, there’s never been a more prominent time for this research to be in the spotlight. 

“There is so much sodium hidden in the foods we eat, that in an ideal world everyone would stop adding salt themselves – be it at home or in a restaurant. Unfortunately, the reality is people just don’t want to stop using salt altogether, so our job is to educate on the simple measures (such as using a reduced sodium salt when cooking and seasoning) which can have a big benefit to overall health and wellbeing. It’s teaching people that small changes don’t need to be difficult, sometimes it’s just simply learning to season with sense.

“Potassium is lacking in many people’s diets (17 per cent of UK adults have intakes that put them at risk of deficiency) so using a reduced-sodium alternative like LoSalt®*, which is two-thirds potassium chloride, can also help increase consumption – which in turn may have a beneficial effect on your blood pressure.”

 

View the coverage in The Times.

 

 

*People receiving medication for diabetes, heart or kidney disorders should consult their doctor before using a reduced sodium salt