Salt substitute explained

A salt substitute, also known as low-sodium salt, is a low-sodium alternative to edible salt (table salt) marketed to reduce the risk of high blood pressure and cardiovascular disease associated with a high intake of sodium chloride[1] while maintaining a similar taste.

The leading salt substitutes are non-sodium table salts, which have their tastes as a result of compounds other than sodium chloride. Non-sodium salts reduce daily sodium intake and reduce the health effects of this element.

Research

In 2021, a large randomised controlled trial of 20,995 older people in China reported that use of a potassium salt substitute in home cooking over a five-year period reduced the risk of stroke by 14%, major cardiovascular events by 13% and all-cause mortality by 12% compared to use of regular table salt.[2] The study reported no significant difference in hyperkalaemia between the two groups, though people with serious kidney disease were excluded from the trial. The salt substitute used was 25% potassium chloride and 75% sodium chloride.

A 2022 Cochrane review of 26 trials involving salt substitutes reported their use probably slightly reduces blood pressure, non-fatal stroke, non-fatal acute coronary syndrome and heart disease death in adults compared to use of regular table salt.[3] A separate systematic review and meta-analysis published in the same year of 21 trials involving salt substitutes reported protective effects of salt substitute on total mortality, cardiovascular mortality and cardiovascular events.[4]

A 2023 clinical trial engaged 1,612 residents of 48 residential care facilities in China. They were cluster-randomized via a 2 × 2 factorial design substituting 62.5% NaCl/25% KCl versus usual salt and progressively restricted versus usual supply for 2 years. The substitute lowered systolic blood pressure (–7.1 mmHg, 95% confidence interval (CI) –10.5 to –3.8), meeting the primary endpoint, whereas restricted vs usual supply had no effect. Substitute lowered diastolic blood pressure (–1.9 mmHg, 95% CI –3.6 to –0.2) and resulted in fewer cardiovascular events (hazard ratio (HR) 0.60, 95% CI 0.38–0.96), but had no effect on total mortality.[5]

Examples

Potassium

Potassium closely resembles the saltiness of sodium. In practice, potassium chloride (also known as potassium salt) is the most commonly used salt substitute. Its toxicity for a healthy person is approximately equal to that of table salt (the is about 2.5 g/kg, or approximately 190 g for a person weighing 75 kg). Potassium lactate may also be used to reduce sodium levels in food products and is commonly used in meat and poultry products.[6] The recommended daily allowance of potassium is higher than that for sodium,[7] yet a typical person consumes less potassium than sodium in a given day.[8] Potassium chloride has a bitter aftertaste when used in higher proportions, which consumers may find unpalatable. As a result, some formulations only replace half the sodium chloride with potassium.[9]

Various diseases and medications may decrease the body's excretion of potassium, thereby increasing the risk of potentially fatal hyperkalemia. People with kidney failure, heart failure, or diabetes are not recommended to use salt substitutes without medical advice. LoSalt, a salt substitute manufacturer, has issued an advisory statement[10] that people taking the following prescription drugs should not use a salt substitute: amiloride, triamterene, Dytac, captopril and other angiotensin-converting enzyme inhibitors, spironolactone, and eplerenone.

Other types

Sodium malate is salty in taste and may be blended with other salt substitutes. Although it contains sodium, the mass fraction is lower.[11]

Monosodium glutamate is often used as a substitute for salt in processed and restaurant food, due to its salty taste and low sodium content compared to table salt, and can also be used effectively in home cooking.[12] [13]

Seaweed granules are also marketed as alternatives to salt.[14]

Dehydrated, pulverized Salicornia (glasswort, marsh samphire) is sold under the brand name "Green Salt" as a salt substitute claimed to be as salty in taste as table salt, but with less sodium.[15] [16]

Historical

Historically (late 20th century), many substances containing magnesium and potassium have been tried as salt substitutes. They include:[17] [18]

Even further back in the early 20th century, lithium chloride was used as a salt substitute for those with hypertension. However, overdosing was common and deaths have occurred, leading to its prohibition in 1949.[19]

Additives

Flavor enhancers, although not true salt alternatives, help reduce the use of salt by enhancing the savory flavor (umami).[20] Hydrolyzed protein[21] or 5'-nucleotides[22] are sometimes added to potassium chloride to improve the flavour of salt substitutes. Fish sauce has the same effect.[23]

Salt substitutes can also be further enriched with the essential nutrients. A salt substitute can, analogously to the problem of iodine deficiency, help to eliminate the "hidden hunger" i.e. insufficient supply of necessary micronutrients such as iron.[24] [25] Such substances are promoted by UNICEF as a "super-salt".[26]

See also

Notes and References

  1. http://www.sacn.gov.uk/pdfs/sacn_salt_final.pdf Salt and Health (PDF). Scientific Advisory Committee on Nutrition (SACN)
  2. Neal . Bruce . Wu . Yangfeng . Feng . Xiangxian . Zhang . Ruijuan . Zhang . Yuhong . Shi . Jingpu . Zhang . Jianxin . Tian . Maoyi . Huang . Liping . Li . Zhifang . Yu . Yan . Zhao . Yi . Zhou . Bo . Sun . Jixin . Liu . Yishu . etal . 2021-09-16 . Effect of Salt Substitution on Cardiovascular Events and Death . New England Journal of Medicine . en . 385 . 12 . 1067–1077 . 10.1056/NEJMoa2105675 . 0028-4793 . 34459569 . free . free . 10044/1/92012.
  3. Brand . Amanda . Visser . Marianne E . Schoonees . Anel . Naude . Celeste E . 2022-08-10 . Cochrane Public Health Group . Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women . Cochrane Database of Systematic Reviews . en . 2022 . 8 . CD015207 . 10.1002/14651858.CD015207 . 9363242 . 35944931.
  4. Yin . Xuejun . Rodgers . Anthony . Perkovic . Adam . Huang . Liping . Li . Ka-Chun . Yu . Jie . Wu . Yangfeng . Wu . J H Y . Marklund . Matti . Huffman . Mark D . Miranda . J Jaime . Di Tanna . Gian Luca . Labarthe . Darwin . Elliott . Paul . Tian . Maoyi . etal . 2022-08-09 . Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis . Heart . en . 108 . 20 . 1608–1615 . 10.1136/heartjnl-2022-321332 . 1355-6037 . 35945000 . 251468854 . free . 1959.4/unsworks_82252. Review in: 10.7326/J22-0091 . In the general population, salt substitutes vs. Regular salt reduce BP levels, CV outcomes, and mortality . 2022 . Brophy . James . Annals of Internal Medicine . 175 . 12 . JC139 . 36469919 . 254247591 .
  5. Yuan . Yifang . Jin . Aoming . Neal . Bruce . Feng . Xiangxian . Qiao . Qianku . Wang . Hongxia . Zhang . Ruijuan . Li . Jiayu . Duan . Peifen . Cao . La’e . Zhang . Hui . Hu . Senke . Li . Huijuan . Gao . Pei . Xie . Gaoqiang . April 2023 . Salt substitution and salt-supply restriction for lowering blood pressure in elderly care facilities: a cluster-randomized trial . Nature Medicine . en . 29 . 4 . 973–981 . 10.1038/s41591-023-02286-8 . 1546-170X.
  6. Low sodium meat products. http://www.corbion.com/
  7. Web site: Dietary Reference Intakes : Electrolytes and Water . 14 August 2011 . The National Academies . 2004 . dead . https://web.archive.org/web/20101011120814/http://www.iom.edu/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Electrolytes_Water.pdf . 11 October 2010 .
  8. Caggiula . AW . RR Wing . MP Nowalk . NC Milas . S Lee . H Langford . 1985 . The measurement of sodium and potassium intake . American Journal of Clinical Nutrition . 42 . 3. 391–398 . 2008-11-17 . 4036845 . 10.1093/ajcn/42.3.391. free .
  9. Drake. S. L.. Drake. M. A.. 2011. Comparison of Salty Taste and Time Intensity of Sea and Land Salts from Around the World. Journal of Sensory Studies. 26. 1. 25–34. 10.1111/j.1745-459X.2010.00317.x. 1745-459X.
  10. LoSalt Advisory Statement (PDF)
  11. Book: Whitmore . Frank C. . Organic Chemistry, Volume One : Part I: Aliphatic Compounds . 2012 . Dover Publications . Mineola, New York . 978-0-486-31115-9 . 397 . 2nd .
  12. Web site: MSG in Cooking . 2024-06-01 . The Glutamate Association . en-US.
  13. Maluly . Hellen D. B. . Arisseto-Bragotto . Adriana P. . Reyes . Felix G. R. . Monosodium glutamate as a tool to reduce sodium in foodstuffs: Technological and safety aspects. . Food Science & Nutrition . November 2017 . 5 . 6 . 1039–1048 . 10.1002/fsn3.499 . 29188030 . 5694874 .
  14. Web site: Seaweed granules may replace salt in foods. foodnavigator.com. 22 September 2008 .
  15. Florence Fabricant, "To Sprinkle: Add Some Green To Your Salt Lineup", New York Times, August 11, 2021, p. D3; online version "Add Green to Your Salt Lineup" August 9, 2021
  16. Web site: Green Salt, the healthy salt alternative. Green Salt.
  17. Lifton. R. P.. 1995-09-12. Genetic determinants of human hypertension.. Proceedings of the National Academy of Sciences. 92. 19. 8545–8551. 10.1073/pnas.92.19.8545. 0027-8424. 41004. 7567973. 1995PNAS...92.8545L . free.
  18. Dahl. Lewis K.. Heine. Martha. Thompson. Keith. January 1974. Genetic Influence of the Kidneys on Blood Pressure: Evidence from Chronic Renal Homografts in Rats with Opposite Predispositions to Hypertension. Circulation Research. 34. 1. 94–101. 10.1161/01.RES.34.1.94. 4588315. 0009-7330. free.
  19. Marmol . F. . Lithium: Bipolar disorder and neurodegenerative diseases Possible cellular mechanisms of the therapeutic effects of lithium . 10.1016/j.pnpbp.2008.08.012 . Progress in Neuro-Psychopharmacology and Biological Psychiatry . 32 . 8 . 1761–1771 . 2008 . 18789369 . 25861243 .
  20. Web site: Everyone should cook with MSG, says food scientist. Lubin. Gus. Business Insider. 2 February 2017. 27 January 2019.
  21. United States Patent 4451494
  22. United States Patent 4243691
  23. Huynh . Hue Linh . Danhi . Robert . Yan . See Wan . 27 November 2015 . Using Fish Sauce as a Substitute for Sodium Chloride in Culinary Sauces and Effects on Sensory Properties . Journal of Food Science . 81 . 1 . S150–S155 . 10.1111/1750-3841.13171 . 26613570.
  24. Afshin. Ashkan. Sur. Patrick John. Fay. Kairsten A.. Cornaby. Leslie. Ferrara. Giannina. Salama. Joseph S. Mullany. Erin C. Abate. Kalkidan Hassen. Abbafati. Cristiana. Abebe. Zegeye. Afarideh. Mohsen. May 2019. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 393. 10184. 1958–1972. 10.1016/S0140-6736(19)30041-8. 30954305. 6899507. free.
  25. Das. Jai K. Salam. Rehana A. Kumar. Rohail. Bhutta. Zulfiqar A. December 2013. Micronutrient fortification of food and its impact on woman and child health: a systematic review. Systematic Reviews. 2. 1. 67. 10.1186/2046-4053-2-67. 2046-4053. 3765883. 23971426 . free .
  26. Web site: VITAMIN & MINERAL DEFICIENCY: A GLOBAL PROGRESS REPORT. 2019-10-25. 2021-01-26. https://web.archive.org/web/20210126025252/http://www.unicef.org/media/files/vmd.pdf. dead.

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