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Pass the potassium and shake up your health

Salt Substitution Research - Hannah Greenwood & Dr Loai Albarqouni

Replacing regular salt with a salt substitute decreases the risk of death from cardiovascular disease by about 17 percent, a new study has found.

Cardiovascular disease accounts for about one-third of all deaths globally and high salt intake accounts for 10 percent of all cardiovascular deaths.

Even though international bodies such as the World Health Organisation and the National Academies of Sciences, Engineering and Medicine recommend reducing salt intake, worldwide consumption of sodium still exceeds the recommended daily limit.  

The researchers behind the systematic review, Hannah Greenwood and Dr Loai Albarqouni of Bond University, said switching table salt with a substitute containing reduced sodium and increased potassium may offer a simple achievable strategy to reduce sodium intake.

Mrs Greenwood, the lead author and a PhD candidate at the university’s Institute for Evidence-Based Healthcare, said salt substitutes contained less sodium and more potassium than regular salt.

“We know that replacing some or all of the sodium chloride in salt with potassium chloride has minimal taste ramifications, but significant cardiovascular impacts,” she said.

“These include, in some instances, reductions in blood pressure comparable to reductions associated with blood-pressure lowering medications.  

“What we found in this review is that this could be a simple and effective way to achieve significant health benefits for a large number of people.”

Most of the studies included in the review were from China or Taiwan and included older people who are at higher risk of cardiovascular disease.

“We conducted a systematic review of 16 randomised control trials from all around the world that analysed long-term substitution of regular table salt for salt substitute products,” Mrs Greenwood said.

“We found evidence that salt substitution can reduce mortality from cardiovascular events including but not limited to stroke, myocardial infarction, and heart failure by about 17 percent and death from any cause by about 12 percent.”

Dr Albarqouni, the senior author and Assistant Professor at Bond University, said cardiovascular disease remained one of the largest killers in Australia and worldwide and the research highlighted the huge public health impacts that shifts in habitual dietary behaviours could have.

Dr Albarqouni said the findings were significant because salt substitution was a low-cost and scalable, with benefits across a range of cardiovascular conditions including stroke.

Professor Paul Glasziou, the Director of the Institute for Evidence-Based Healthcare, said the study also emphasised the need for health educators to consider the effectiveness of non-drug interventions more thoroughly. 

“Non-pharmaceutical treatments - which include exercise, psychotherapy, manual procedures, and self-management - are often as, or more, effective and safe as their drug counterpart,” Professor Glasziou said.

“However, they are generally poorly described, marketed, and taught and therefore often underused in healthcare.”

Dr Albarqouni is a NHMRC Emerging Leader Fellow whose research expertise includes evidence-informed decision-making, effective non-drug interventions, as well as overdiagnosis and overuse of healthcare services in limited resources settings.

Mrs Greenwood, Dr Albarqouni’s PhD student, is looking at how use of non-drug interventions can be increased in healthcare systems. 

The research was conducted in collaboration with dietetics researchers Professor Lauren Ball of The University of Queensland and Dr Katelyn Barnes of Australian National University. 

The research has been published in Annals of Internal Medicine, the official journal of the American College of Physicians.

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