Salt substitute

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A salt substitute AlsoSalt.jpg
A salt substitute

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.

Contents

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.

Low sodium diet

This section is an excerpt from Low sodium diet.[ edit ]

A low sodium diet is a diet that includes no more than 1,500 to 2,400 mg of sodium per day. [2]

The human minimum requirement for sodium in the diet is about 500 mg per day, [3] which is typically less than one-sixth as much as many diets "seasoned to taste". For certain people with salt-sensitive blood pressure or diseases such as Ménière's disease, this extra intake may cause a negative effect on health.

WHO guidelines [4] [5] state that adults should consume less than 2,000 mg of sodium/day (i.e. about 5 grams of traditional table salt), and at least 3,510 mg of potassium per day. [6] In Europe, adults and children consume about twice as much sodium as recommended by experts. [7]

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. [8] 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. [9] 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. [10]

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. [11]

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 LD50 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. [12] The recommended daily allowance of potassium is higher than that for sodium, [13] yet a typical person consumes less potassium than sodium in a given day. [14] 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. [15]

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 [16] 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. [17]

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. [18] [19]

Seaweed granules are also marketed as alternatives to salt. [20]

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. [21] [22]

Historical

Historically (late 20th century), many substances containing magnesium and potassium have been tried as salt substitutes. They include: [23] [24]

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. [25]

Additives

Flavor enhancers, although not true salt alternatives, help reduce the use of salt by enhancing the savory flavor (umami). [26] Hydrolyzed protein [27] or 5'-nucleotides [28] are sometimes added to potassium chloride to improve the flavour of salt substitutes. Fish sauce has the same effect. [29]

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. [30] [31] Such substances are promoted by UNICEF as a "super-salt". [32]

See also

Related Research Articles

<span class="mw-page-title-main">Potassium</span> Chemical element with atomic number 19 (K)

Potassium is a chemical element; it has symbol K and atomic number 19. It is a silvery white metal that is soft enough to easily cut with a knife. Potassium metal reacts rapidly with atmospheric oxygen to form flaky white potassium peroxide in only seconds of exposure. It was first isolated from potash, the ashes of plants, from which its name derives. In the periodic table, potassium is one of the alkali metals, all of which have a single valence electron in the outer electron shell, which is easily removed to create an ion with a positive charge. In nature, potassium occurs only in ionic salts. Elemental potassium reacts vigorously with water, generating sufficient heat to ignite hydrogen emitted in the reaction, and burning with a lilac-colored flame. It is found dissolved in seawater, and occurs in many minerals such as orthoclase, a common constituent of granites and other igneous rocks.

<span class="mw-page-title-main">Sodium</span> Chemical element with atomic number 11 (Na)

Sodium is a chemical element; it has symbol Na and atomic number 11. It is a soft, silvery-white, highly reactive metal. Sodium is an alkali metal, being in group 1 of the periodic table. Its only stable isotope is 23Na. The free metal does not occur in nature and must be prepared from compounds. Sodium is the sixth most abundant element in the Earth's crust and exists in numerous minerals such as feldspars, sodalite, and halite (NaCl). Many salts of sodium are highly water-soluble: sodium ions have been leached by the action of water from the Earth's minerals over eons, and thus sodium and chlorine are the most common dissolved elements by weight in the oceans.

<span class="mw-page-title-main">Hypertension</span> Long-term high blood pressure in the arteries

Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia. Hypertension is a major cause of premature death worldwide.

<span class="mw-page-title-main">Potassium chloride</span> Ionic compound (KCl)

Potassium chloride is a metal halide salt composed of potassium and chlorine. It is odorless and has a white or colorless vitreous crystal appearance. The solid dissolves readily in water, and its solutions have a salt-like taste. Potassium chloride can be obtained from ancient dried lake deposits. KCl is used as a fertilizer, in medicine, in scientific applications, domestic water softeners, and in food processing, where it may be known as E number additive E508.

In the U.S. and Canada, the Reference Daily Intake (RDI) is used in nutrition labeling on food and dietary supplement products to indicate the daily intake level of a nutrient that is considered to be sufficient to meet the requirements of 97–98% of healthy individuals in every demographic in the United States. While developed for the US population, it has been adopted by Canada.

<span class="mw-page-title-main">Potassium in biology</span> Use of Potassium by organisms

Potassium is the main intracellular ion for all types of cells, while having a major role in maintenance of fluid and electrolyte balance. Potassium is necessary for the function of all living cells and is thus present in all plant and animal tissues. It is found in especially high concentrations within plant cells, and in a mixed diet, it is most highly concentrated in fruits. The high concentration of potassium in plants, associated with comparatively very low amounts of sodium there, historically resulted in potassium first being isolated from the ashes of plants (potash), which in turn gave the element its modern name. The high concentration of potassium in plants means that heavy crop production rapidly depletes soils of potassium, and agricultural fertilizers consume 93% of the potassium chemical production of the modern world economy.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

<span class="mw-page-title-main">Electrolyte imbalance</span> Abnormality in the concentration of electrolytes in the body

Electrolyte imbalance, or water-electrolyte imbalance, is an abnormality in the concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis in the body. They help to regulate heart and neurological function, fluid balance, oxygen delivery, acid–base balance and much more. Electrolyte imbalances can develop by consuming too little or too much electrolyte as well as excreting too little or too much electrolyte. Examples of electrolytes include calcium, chloride, magnesium, phosphate, potassium, and sodium.

<span class="mw-page-title-main">Healthy diet</span> Type of diet

A healthy diet can help prevent all forms of malnutrition, as well as non-communicable diseases such as diabetes, heart disease, stroke and cancer. Unhealthy diet and physical inactivity are major global health risks. A healthy diet is a diet that maintains or improves overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients such as protein, micronutrients such as vitamins, and adequate fibre and food energy.

<span class="mw-page-title-main">Salt</span> Mineral used as food ingredient, composed primarily of sodium chloride

In common usage, salt is a mineral composed primarily of sodium chloride (NaCl). When used in food, especially in granulated form, it is more formally called table salt. In the form of a natural crystalline mineral, salt is also known as rock salt or halite. Salt is essential for life in general, and saltiness is one of the basic human tastes. Salt is one of the oldest and most ubiquitous food seasonings, and is known to uniformly improve the taste perception of food, including otherwise unpalatable food. Salting, brining, and pickling are also ancient and important methods of food preservation.

Magnesium deficiency is an electrolyte disturbance in which there is a low level of magnesium in the body. Symptoms include tremor, poor coordination, muscle spasms, loss of appetite, personality changes, and nystagmus. Complications may include seizures or cardiac arrest such as from torsade de pointes. Those with low magnesium often have low potassium.

The Dietary Approaches to Stop Hypertension or the DASH diet is a diet to control hypertension promoted by the U.S.-based National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH), an agency of the United States Department of Health and Human Services. The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods. It includes meat, fish, poultry, nuts, and beans, and is limited in sugar-sweetened foods and beverages, red meat, and added fats. In addition to its effect on blood pressure, it is designed to be a well-balanced approach to eating for the general public. DASH is recommended by the United States Department of Agriculture (USDA) as a healthy eating plan. The DASH diet is one of three healthy diets recommended in the 2015–20 U.S. Dietary Guidelines, which also include the Mediterranean diet and a vegetarian diet. The American Heart Association (AHA) considers the DASH diet "specific and well-documented across age, sex and ethnically diverse groups."

A low sodium diet is a diet that includes no more than 1,500 to 2,400 mg of sodium per day.

<span class="mw-page-title-main">Sodium in biology</span> Use of sodium by organisms

Sodium ions are necessary in small amounts for some types of plants, but sodium as a nutrient is more generally needed in larger amounts by animals, due to their use of it for generation of nerve impulses and for maintenance of electrolyte balance and fluid balance. In animals, sodium ions are necessary for the aforementioned functions and for heart activity and certain metabolic functions. The health effects of salt reflect what happens when the body has too much or too little sodium. Characteristic concentrations of sodium in model organisms are: 10 mM in E. coli, 30 mM in budding yeast, 10 mM in mammalian cell and 100 mM in blood plasma.

On October 25, 2007, the Minister of Health announced that the Government of Canada would establish an expert Sodium Working Group to explore options for reducing sodium intake and cardiovascular disease among Canadians.

A health claim found on a food labels and in food marketing is a claim by a food manufacturer that their product will reduce the risk of developing a disease or condition.

<span class="mw-page-title-main">Salt and cardiovascular disease</span> Association between salt consumption and cardiovascular disease

Salt consumption has been extensively studied for its role in human physiology and impact on human health. Chronic, high intake of dietary salt consumption is associated with hypertension and cardiovascular disease, in addition to other adverse health outcomes. Major health and scientific organizations, such as the World Health Organization, US Centers for Disease Control and Prevention, and American Heart Association, have established high salt consumption as a major risk factor for cardiovascular diseases and stroke.

<span class="mw-page-title-main">Health effects of salt</span> Conditions associated with the consumption of either too much or too little salt

The health effects of salt are the conditions associated with the consumption of either too much or too little salt. Salt is a mineral composed primarily of sodium chloride (NaCl) and is used in food for both preservation and flavor. Sodium ions are needed in small quantities by most living things, as are chlorine ions. Salt is involved in regulating the water content of the body. Both sodium and chlorine ions are used for electrical signaling in the nervous system, among other biological roles.

<span class="mw-page-title-main">Calcium supplement</span> Dietary mineral supplement

Calcium supplements are salts of calcium used in a number of conditions. Supplementation is generally only required when there is not enough calcium in the diet. By mouth they are used to treat and prevent low blood calcium, osteoporosis, and rickets. By injection into a vein they are used for low blood calcium that is resulting in muscle spasms and for high blood potassium or magnesium toxicity.

A renal diet is a diet aimed at keeping levels of fluids, electrolytes, and minerals balanced in the body in individuals with chronic kidney disease or who are on dialysis. Dietary changes may include the restriction of fluid intake, protein, and electrolytes including sodium, phosphorus, and potassium. Calories may also be supplemented if the individual is losing weight undesirably.

References

  1. ↑ Salt and Health (PDF). Scientific Advisory Committee on Nutrition (SACN)
  2. ↑ Heart Failure Society of America, How to follow a low sodium diet
  3. ↑ Implementing recommendations for dietary salt reduction: Where are we? DIANE Publishing. ISBN   1428929096.
  4. ↑ "WHO issues new guidance on dietary salt and potassium" (Press release). WHO. 31 January 2013.
  5. ↑ Guideline Sodium Intake for Adults and Children. Geneva, Switzerland: World Health Organization. 2012. ISBN   978-92-4-150483-6. OCLC   849715509.
  6. ↑ Jarosz, Mirosław; Rychlik, Ewa; Stoś, Katarzyna; Wierzejska, Regina; Wojtasik, Anna; Charzewska, Jadwiga; Mojska, Hanna; Szponar, Lucjan; Sajór, Iwona (2017). Normy żywienia dla populacji Polski (in Polish). Warszawa: Instytut Żywności i Żywienia. ISBN   978-83-86060-89-4. OCLC   1022820929.
  7. ↑ Powles, John; Fahimi, Saman; Micha, Renata; Khatibzadeh, Shahab; Shi, Peilin; Ezzati, Majid; Engell, Rebecca E.; Lim, Stephen S.; Danaei, Goodarz; Mozaffarian, Dariush; Group (NutriCoDE), on behalf of the Global Burden of Diseases Nutrition and Chronic Diseases Expert (2013-12-01). "Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide". BMJ Open. 3 (12): e003733. doi:10.1136/bmjopen-2013-003733. ISSN   2044-6055. PMC   3884590 . PMID   24366578.
  8. ↑ 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; et al. (2021-09-16). "Effect of Salt Substitution on Cardiovascular Events and Death". New England Journal of Medicine. 385 (12): 1067–1077. doi: 10.1056/NEJMoa2105675 . hdl: 10044/1/92012 . ISSN   0028-4793. PMID   34459569.
  9. ↑ Brand, Amanda; Visser, Marianne E; Schoonees, Anel; Naude, Celeste E (2022-08-10). Cochrane Public Health Group (ed.). "Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women". Cochrane Database of Systematic Reviews. 2022 (8): CD015207. doi:10.1002/14651858.CD015207. PMC   9363242 . PMID   35944931.
  10. ↑ 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; et al. (2022-08-09). "Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis". Heart. 108 (20): 1608–1615. doi:10.1136/heartjnl-2022-321332. hdl: 1959.4/unsworks_82252 . ISSN   1355-6037. PMID   35945000. S2CID   251468854. Review in: Brophy, James (2022). "In the general population, salt substitutes vs. Regular salt reduce BP levels, CV outcomes, and mortality". Annals of Internal Medicine. 175 (12): JC139. doi:10.7326/J22-0091. PMID   36469919. S2CID   254247591.
  11. ↑ 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. 29 (4): 973–981. doi:10.1038/s41591-023-02286-8. ISSN   1546-170X.
  12. ↑ Low sodium meat products. http://www.corbion.com/
  13. ↑ "Dietary Reference Intakes : Electrolytes and Water" (PDF). The National Academies. 2004. Archived from the original (PDF) on 11 October 2010. Retrieved 14 August 2011.
  14. ↑ 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. doi: 10.1093/ajcn/42.3.391 . PMID   4036845 . Retrieved 2008-11-17.
  15. ↑ 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. doi:10.1111/j.1745-459X.2010.00317.x. ISSN   1745-459X.
  16. ↑ LoSalt Advisory Statement (PDF) Archived 2008-06-26 at the Wayback Machine
  17. ↑ Whitmore, Frank C. (2012). Organic Chemistry, Volume One : Part I: Aliphatic Compounds (2nd ed.). Mineola, New York: Dover Publications. p. 397. ISBN   978-0-486-31115-9.
  18. ↑ "MSG in Cooking". The Glutamate Association. Retrieved 2024-06-01.
  19. ↑ Maluly, Hellen D. B.; Arisseto-Bragotto, Adriana P.; Reyes, Felix G. R. (November 2017). "Monosodium glutamate as a tool to reduce sodium in foodstuffs: Technological and safety aspects". Food Science & Nutrition. 5 (6): 1039–1048. doi:10.1002/fsn3.499. PMC   5694874 . PMID   29188030.
  20. ↑ "Seaweed granules may replace salt in foods". foodnavigator.com. 22 September 2008.
  21. ↑ 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
  22. ↑ "Green Salt, the healthy salt alternative". Green Salt.
  23. ↑ Lifton, R. P. (1995-09-12). "Genetic determinants of human hypertension". Proceedings of the National Academy of Sciences. 92 (19): 8545–8551. Bibcode:1995PNAS...92.8545L. doi: 10.1073/pnas.92.19.8545 . ISSN   0027-8424. PMC   41004 . PMID   7567973.
  24. ↑ 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. doi: 10.1161/01.RES.34.1.94 . ISSN   0009-7330. PMID   4588315.
  25. ↑ Marmol, F. (2008). "Lithium: Bipolar disorder and neurodegenerative diseases Possible cellular mechanisms of the therapeutic effects of lithium". Progress in Neuro-Psychopharmacology and Biological Psychiatry. 32 (8): 1761–1771. doi:10.1016/j.pnpbp.2008.08.012. PMID   18789369. S2CID   25861243.
  26. ↑ Lubin, Gus (2 February 2017). "Everyone should cook with MSG, says food scientist". Business Insider. Retrieved 27 January 2019.
  27. ↑ United States Patent 4451494
  28. ↑ United States Patent 4243691
  29. ↑ 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. doi:10.1111/1750-3841.13171. PMID   26613570.
  30. ↑ 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. doi: 10.1016/S0140-6736(19)30041-8 . PMC   6899507 . PMID   30954305.
  31. ↑ 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. doi: 10.1186/2046-4053-2-67 . ISSN   2046-4053. PMC   3765883 . PMID   23971426.
  32. ↑ "VITAMIN & MINERAL DEFICIENCY: A GLOBAL PROGRESS REPORT" (PDF). Archived from the original (PDF) on 2021-01-26. Retrieved 2019-10-25.
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