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Nutritional Pearls: Salt Substitutes

Dawn is a 59-year-old woman with a history of elevated blood pressure levels bordering on hypertension. She admits to ocasionally choosing frozen or boxed meals but generally cooks for herself.

She wants to know if there is any way to lower her blood pressure levels without drastically changing her diet and lifestyle.

How would you advise your patient?

What is the correct answer?
(Answer and discussion on next page)

Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources include special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance.

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Answer: Target lower sodium convenience meals (450 mg to 500 mg) and try salt substitues when cooking at home.

It is estimated that American adults have an average daily sodium intake ranging between as low as 3000 mg to as high as 10,000 mg (that's over 4 teaspoons!). As primary care practitioners, it is clear that sodium reduction is a key component of how we can and should help our patients.

Prepared foods, including frozen and boxed meals, have been identified as a major source of sodium in people's diets. In our own food reviews,1 we have noted that some companies have turned to using salt substitutes—eg, potassium chloride—to reduce the amount of sodium in their foods while still maintaining that salty flavor people seem to crave.1 We've even tested salt substitutes, such as AlsoSalt.2
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There is some pressure on prepared food companies to reduce the amount of sodium in their foods without resorting to substitutes, but for many of our patients added salt is an issue. We know that reducing salt intake can help reduce blood pressure but there has been less research into salt substitutes. 

The Research

Researchers in China conducted a meta-analysis of 5 studies that collectively lasted 6 months and included a total of nearly 2000 participants, including individuals who were hypertensive, normotensive, or at high-risk for cardiovascular disease.3 The studies compared individuals using some type of salt substitute with those using regular salt in their food.

The Results

After pooling the data, the researchers found that systolic blood pressure measured an average 5 mm lower in those using salt substitutes, and diastolic blood pressure averaged 1.5 points lower. The difference was greater in individuals with established hypertension (5.7 mm and 2.4 mm, respectively).

The authors noted that none of the participants had renal failure or congestive heart failure that might be affected by using salt substitutes, since most salt substitutes are made with at least some potassium chloride.

What’s the “Take Home”?

Salt substitutes appear to be helpful in lowering blood pressure in hypertensive patients. A 5 mm reduction could be the difference between a patient measuring at borderline or at target; salt substitutes combined with Mediterranean or DASH diets can be more significant. 

Patients looking to reduce their salt intake by using salt substitutes should be warned that these salts can sometimes leave a bitter, metallic taste. They might try making the change gradually until they find the level of salty versus metallic flavor that's right for them.

References:

  1. Harlan T. Good news about salt substitutes. Dr Gourmet. http://www.drgourmet.com/index.shtml#.VHzIoodHjVU. Accessed December 1, 2014.
  2. Harlan T. Also salt. Dr Gourmet. http://www.drgourmet.com/newsletter/reviews/092807.shtml. Accessed December 1, 2014.
  3. Peng Y, Li W, Wen X, et al. Effects of salt substitutes on blood pressure: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2014;100(6):1448-1454.