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Salt substitution linked with lower risk for dying early, study finds

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Using less salt in your food may seem boring, but the benefits could be as great as a reduced risk of death, new research suggests.

Using a salt substitute when cooking was associated with a lower risk of dying prematurely from any cause or cardiovascular disease, according to a new study published Monday in the journal Annals of Internal Medicine.

“We are pleased to be able to provide evidence that salt replacements are effective in improving cardiovascular outcomes when used long-term, up to 10 years,” said lead study author Dr. Loai Albarqouni, Assistant Professor at the Institute for Evidence- Based in health at Bond University in Australia. “Previous summaries tended to focus on short-term results, lasting only two weeks. »

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Using a salt substitute could reduce your risk of dying prematurely, new research suggests.

The study is a systematic review of 16 randomized controlled trials published before August 23, 2023 and involving 35,251 participants with an average age of approximately 64 years and a higher than average risk of cardiovascular disease. The trials took place mainly in China, with the rest in the United Kingdom, Taiwan, Peru, the Netherlands and Norway.

With two-thirds of the results coming from China, the authors “were surprised at how little research on salt substitution has been done outside of Asian countries,” Albarqouni said. “This is part of the reason we rated the evidence as ‘low to very low certainty’ for Western populations – there is simply not enough evidence to verify that salt substitutes would be as effective in the Western context.”

Salt substitution was also associated with a reduction in urine sodium and blood pressure, an effect similar to that of blood pressure medications, the authors found. This could explain the reduced risk of death, Albarqouni said.

The authors acknowledged that during the trials, some salt substitutes were not tested and that some were purchased by the participants instead of given to them by the researchers.

The trials compared the use of common salt – composed of approximately 100% sodium chloride, sometimes with added iodine – to the use of a salt substitute composed of 25 to 30% potassium chloride and 60 75% sodium chloride.

Another reason why it is difficult to apply the results to a Western context is that salt consumption patterns in North America are “driven by processed and takeout foods, whereas consumption in the research context is more determined by the large amount of salt added during food preparation at home.” » said Albarqouni.

“It’s not the strongest study on which to base many conclusions at this point,” said Dr. Andrew Freeman, a preventive cardiologist and director of cardiovascular prevention and wellness at National Jewish Health in Denver. “But this adds to the body of evidence and the signal in the noise that getting rid of sodium salt in your diet is a big plus and that it is better to have potassium in your diet,”

And “even though we know potassium is beneficial, salt is still salt,” added Freeman, who was not involved in the study. “If it’s sodium chloride, potassium chloride or magnesium chloride, it’s all salt. And the best way to get potassium in your body is to eat fruits and vegetables – that’s where potassium is most abundant.

The American Heart Association’s ideal daily sodium limit is 1,500 milligrams per day for most adults, especially those with high blood pressure, and no more than 2,300 milligrams per day.

“If the majority of your food intake comes from packaged or restaurant-bought foods, it’s likely that your sodium intake is too high,” Albarqouni said by email. “There are a few physical signs that you are eating too much sodium, such as bloating or swelling, fatigue, high blood pressure, thirst and/or increased urination. »

If you are concerned about your consumption, you can seek medical or nutritional advice from a professional, Albarqouni added.

When buying packaged foods, check the sodium content on the labels. Some foods may have more sodium than you think, like poultry or grains, Freeman said. A standard-size pickle typically contains about 1,500 milligrams of salt, he added.

In addition to reducing salt intake by simply eliminating salt in your home cooking, you can also try purchasing salt substitutes with a similar composition to those used in the study or using salt-free seasonings to add more flavor to food, experts said.

The authors acknowledged that more research is needed to confirm whether salt substitution like that in the study is safe for patients “sensitive to micronutrient manipulation,” including those sensitive to potassium, such as people with kidney failure, they said.

Foods with less salt may seem boring at first, but your taste buds can adapt in just a few weeks, Freeman said, so give yourself time to adjust.

“It’s also important to remember that reducing sodium intake is only one way to reduce cardiovascular risk without medication,” Albarqouni said. “Things like diet changes, stopping smoking and increasing physical activity can also have an impact. Salt substitutes are not a holy grail for eliminating cardiovascular disease, but they are one piece of the puzzle that can help.

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