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Salt substitutes may help lower the risk of heart attack, stroke

Researchers used 21 international studies involving nearly 30,000 people in western Europe, the Western Pacific, the Americas, and South-East Asia.

Salt substitutes could lower your risk of heart attack, stroke, and death from all causes, according to a new review of studies published in the online journal Heart.

Researchers said it didn’t matter where the person lived, their age, sex, weight, or history of high blood pressure. They reported that reducing salt intake by switching to a salt substitute lowered blood pressure. This finding was across the board.

Overall, salt substitutes lowered the risk:

  • Of early death from any cause by 11%
  • For cardiovascular disease by 13%
  • Of heart attacks by 11%

Because salt substitutes contain more potassium, the scientists looked at whether that would have adverse health effects. They reported that it did not.

Medical professionals have long known that salt consumption is a risk factor for high blood pressure. The American Heart Association recommends a maximum of 2,300 milligrams (mg) per day of salt, ideally, no more than 1,500 mg per day, especially for people with high blood pressure. Cutting back by 1,000 mg can improve your health.

People with certain health conditions should tightly regulate their salt intake.

“Adults with diagnosed high blood pressure should not consume more than 1,500 mg of sodium per day, which would be roughly half a teaspoon of salt,” Trista Best MPH, RD, LD, a consultant with Balance One Supplements, told Healthline. “Other conditions where salt intake should be regulated include those with kidney disease, history of kidney stones, or anyone susceptible to osteoporosis. This is because salt causes the kidneys to excrete calcium into the urine. This puts strain on the kidneys and potential damage to the bones.”

Many people use salt substitutes to reduce salt intake.

“Salt substitutes, which contain potassium chloride rather than sodium chloride, are one way to add flavor to food while reducing sodium intake,” says Dr. David Cutler, a family medicine physician at Providence Saint John’s Health Center in California. “However, people with impaired kidney function or taking certain medication must be careful not to ingest too much potassium. Still, for most people, an increased potassium diet can improve health outcomes.” “A recent study found that substituting sodium chloride with potassium chloride in the diet lowered elevated blood pressure,” Cutler told Healthline. “These reductions in blood pressure appeared to be consistent across geographical regions and population subgroups of age, sex, history of hypertension, body mass index, and baseline blood pressure. In other words, lower salt was good for everyone.”

The new study showed that the potassium in salt substitutes lowered blood pressure. Some people take that to mean using a potassium supplement can help reduce their blood pressure. But taking potassium supplements isn’t necessarily good for you.

“I would not recommend specifically adding a potassium supplement to one’s diet, as potassium levels need to be tightly regulated for the body to function appropriately, explained Dr. Rigved Tadwalkar, a board-certified cardiologist at Providence Saint John’s Health Center. “However, studies such as this demonstrate that consuming potassium incorporated within a salt substitute can benefit blood pressure lowering and cardiovascular health. We also know that consuming potassium-rich foods, including certain greens, fruits, and yogurts, can decrease the risk of cardiovascular disease, mediated by the blood pressure lowering effect.”

Today, there are different types of salt to choose from:

  • Table salt
  • Kosher salt
  • Pickling salt
  • Himalayan Pink Salt
  • Black Salt
  • Sea Salt

Is there much of a difference between them? Could one be better for you than another?

Probably not, according to Matthew Black, MS, RDN, LD, a registered dietitian at The Ohio State University Wexner Medical Center.

“It is a common misconception that alternative types of salt, such as sea, Himalayan, and kosher, are somehow better for you in terms of their sodium content,” Black told Healthline. “Since all these salt types contain sodium primarily, they too should be heavily limited in usage. Using different salt types might be ideal in terms of cooking and taste preferences, but make no mistake, all of them can increase your risks of high blood pressure, heart attack, stroke, and early death, the same as traditional table salt. The best practice when using alternate salt types would be to purchase those with nutrition information which states the amount of sodium per serving and factor that into your daily intake.” The average person may find it is challenging to reduce sodium intakes to the eventual recommended goal of 1,500 mg per day,” continued Black. “This will require following a mostly whole food diet, in which very little of what you eat is processed. However, there are plenty of ways to season foods without using sodium or potassium-based salts. Try fresh or freeze-dried herbs and spices to add flavor or heat to dishes using fresh or dried ground peppers. Or, you could try making your sodium-free seasoning blends.”

Salt substitutes may help lower the risk of heart attack, stroke

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