Tuesday, August 9

Hypertension: salt substitutes are not so good for cardiovascular health

Sodium is hidden in a long list of prepared, fast and processed foods.

Photo: Photo of Artem Beliaikin in Pexels / Pexels

By now we all know about devastating effects of salt consumption, the most common form of sodium. It is one of the most used additives in the food industry, it is usually added to food during its manufacturing process, in homemade food and at the center of the table, with the aim of enhancing the flavor and prolonging the shelf life of food. In such a way that one of the main tips to improve cardiovascular health is to reduce salt intake. Finally, it is no secret to say that diets high in sodium increase the risk of high blood pressure, cardiovascular disease and heart attack, considered the main risk factors for stroke.

Based on the above, it is no secret to say that every day more people are interested in considerably reducing their salt intake, although avoiding ultra-processed foods and fast foods is one of the strongest measures. In recent months, much has been said about the benefits of integrating the use of salt substitutes into the daily diet and in fact there have been various studies that support it.

One of the most relevant was a study published at the beginning of September of this year, by the New England Journal of Medicine. In this research work it was confirmed that the simple act of changing table salt for salt substitutes can help reduce the risk of stroke in people over the age of 60 with a history of high blood pressure or previous stroke. The research included almost 21,000 participants and was carried out in 600 villages in rural areas of five provinces in China.

As an important background it is worth mentioning that 72% of the study participants had a history of stroke and 88% of high blood pressure. Participants received free salt substitutes with a formulation of approximately 75% sodium chloride and 25% potassium chloride, as a replacement for regular salt and they were recommended to use them for cooking, seasoning and preserving food. They were also encouraged to use the salt substitute more sparingly than before to maximize sodium reduction.

Sufficient salt substitute was provided to meet the needs of the entire household (about 20 grams per person per day). Participants from other villages continued with their usual cooking and eating habits. According to the statements of the lead author of the study, Dr. Bruce Neal who is Professor at the George Institute for Global Health in Sydney, Australia: “This study provides clear evidence for an intervention that could be undertaken very quickly at a very low cost. Now we have shown that it is effective and these are the benefits for China only. Substitution of salt could be used by billions more with even greater benefits. ”

The study findings raised questions from experts around the world, one of the main questions that arose was whether This type of dynamic is applicable in the United States and other countries outside of China. As stated by Dr. Elizabeth Klodas, a Minneapolis-based cardiologist and founder of Step One Foods: “Although I wish I could say yes, it is more realistic to say that it is probably not feasible to replicate this scheme in other countries.” Additionally, Klodas noted that since the study looked at high-risk populations, the findings may not translate to other populations (for example, people without high blood pressure and without a prior stroke). Another aspect that we cannot fail to point out is that It was a study focused on a unique cultural group, with specific dietary habits and patterns. Therefore, it may not be translated to other populations.

Complementary to this, it is necessary to mention that the greatest barrier to reducing sodium intake in the United States is that much of the salt intake is sadly not under the control of the majority of the population. In rural China, most meals are cooked from scratch, so sodium intake is under the control of the food preparer. Nevertheless, Americans eat far more processed and prepared foods, and many of these products add a lot of sodium even without touching the salt shaker.

Also, it goes without saying that sodium lurks almost anywhere. For example: a simple bagel, can provide 450 milligrams of sodium, even before adding any ingredient and that are normally rich in salt such as smoked salmon, cheeses, sausages and sauces. Taking into account that the maximum recommended sodium intake is 2,300 milligrams per dayStarting the day with a simple piece of bagel is about 20% of a full day’s sodium allowance. In such a way that sodium substitutes are not of great help in these cases and in general in everyday life, especially taking into account the lifestyle of modern society.

Returning to the study, there is another really worrying point: the initial salt intake was very high, it was supposed to be up to 20 grams of salt per person per day; so the observed effect may not translate to those who consume less salt to begin with.

Among the main conclusions that several experts agree on, we can say that in theory a salt substitute could improve cardiovascular risk, especially talking about its benefits for greater control of high blood pressure. However, everything has a price: potassium chloride as a substitute is a problem, as we age, our kidney function naturally slows down. It is worth mentioning that kidney function is a concept that is measured by the glomerular filtration rate or GFR, the kidneys are the body’s filtration system and therefore the natural aging process will slow down the GFR. The problem? Integrating potassium directly into food as a condiment will adversely affect the kidneys, the same as salt.

The most sustainable long-term solution is to bet on follow a natural diet based on the consumption of fresh and seasonal foods. The most important thing is to take on the task of preparing food at home. While it is clear that fast, frozen and ultra-processed foods should be avoided at all costs, it is just as important to stop using processed foods to cook at home. And by this we mean sauces, condiments, dressings, canned goods, bread, cookies, and a long list of products that we tend to think of are sodium-free. Remember to always read the labels and bet on the use of reduced sodium products.

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