Heart disease and strokes kill millions worldwide each year. But what if reducing your risk required just one tiny change you’d barely notice? A groundbreaking new study suggests exactly that. But is it really so simple? We’ll take a look at the findings in this article and what they mean for your health in the real world.
Table of Contents
The salt-substitute study
This new study is part of a massive effort to track the impact of a simple dietary change on health outcomes. It involved 15,000 people living in 600 villages in rural China. Participants had a history of stroke and were at least 60 years old when the study began [1].
The study design was simple. One group, the control group, made no changes to their diet. The other group made one very simple adjustment. They followed up for a period of 5 years to see how many people in each group would have another stroke.
Here’s what they discovered. That little adjustment made a big difference. The group that made the change had a 14% lower risk of another stroke [1].
What’s more, they cut their risks even more dramatically for a particularly serious kind of stroke — a hemorrhagic stroke. This is when a blood vessel in the brain ruptures, causing bleeding inside the brain. It’s like a pipe bursting in your home. Water flows out where it shouldn’t be, and it can cause a lot of damage. Those making the change cut their risk for this kind of stroke by an incredible 30% [1].
Finally, the overall death rate for the intervention group was 12% lower [1].
So here’s the exciting finding of this study: People cut their overall death rate by an impressive 12% by making a tiny change. What’s the change? Moving from regular salt to a salt substitute. Regular salt is sodium chloride. The salt substitute used in the study switched out 25% of the salt with potassium chloride. So it literally just comes down to putting something different in your salt shaker.
Why salt substitutes help
But notice the study focus. It was just people over 60 with a history of stroke. This raises a natural question: Will salt substitutes help the broader population that doesn’t fit into that category? And is it really so simple?
To answer this, we need to start by understanding why salt substitutes would help anyone. What’s the connection here with strokes?
It all starts with blood pressure. This is a measure of how strongly your blood is pressing against the walls of your blood vessels. Think of it like the pressure in your garden hose. Every hose has a pressure rating. If the pressure goes too high, the hose can be damaged or even rupture. It’s the same with our blood vessels. Over time, the damage from high blood pressure drives up the risk of heart attacks and strokes.
Now there are a number of factors that determine our blood pressure. It turns out an important one is salt. Regular table salt has sodium in it, which causes our bodies to retain more water. That extra fluid increases the volume of our blood. And when volume goes up, pressure rises.
The research is clear that eating a high-salt diet is connected to high blood pressure. As sodium intake goes up, so does blood pressure [2].
And here’s where the salt substitute comes in. It has a lower percentage of sodium than normal salt. So it helps us reduce sodium intake even if we don’t cut back on salt intake — at least for meals we prepare at home.
But there’s a crucial bonus with salt substitutes. Recall that the salt substitute used in the study we looked at above had 25% potassium chloride. That gives us potassium, which also connects to blood pressure. It helps in two ways. First, it regulates sodium levels in the blood, keeping them under control.
One study even suggested that when people have an increased intake of potassium, high intake of sodium is not associated with higher blood pressure [3].
Potassium also helps with the effects of our stress response. Stress hormones tighten our blood vessels, restricting flow. Potassium has the opposite effect. It stimulates muscles in the walls of blood vessels to relax, creating more room for blood flow. This reduces blood pressure [4].
So salt substitutes kill two birds with one stone. They reduce sodium intake and they boost potassium intake. Both have been shown to help reduce blood pressure. As we already saw, salt substitutes helped lower risks for those who had already had a stroke. But what about for others?
Stroke victims were just a subgroup of the main study, but the numbers for the overall study matched those for the subgroup. The risk of death was cut by 12% [5].
But there’s one other subgroup from the same research that reveals something important when it comes to salt substitutes. It investigated the question of who benefits most from using them. One of the groups identified was non-obese patients with high blood pressure [6].
Here’s the lesson: Other risk factors — not just high blood pressure — are really important. It’s tempting to think of something like salt substitutes as a magic bullet that will produce big impacts without us making any other changes. But health doesn’t work that way. We need to take a holistic approach. If we’re serious about reducing blood pressure — and therefore lowering our risks for things like strokes and heart attacks — we need to make some broader shifts in our habits.
Diet modifications
So which shifts are the most strategic? I recommend three to my patients. Together, they can produce truly dramatic results, and anyone can do them.
Shift One: Eat more potassium-rich foods
It appears the impact of upping our potassium intake is potentially stronger than lowering our sodium. A careful analysis of the new study on salt substitutes estimated the proportion of blood pressure reduction due to the added potassium ranged from 61–88% [7].
As we saw above, another study found high potassium intake to effectively blunt the blood pressure impact of sodium intake [3]. Ideally, we’ll want to both keep sodium intake low and boost potassium. But because most of us don’t get very much potassium in our diets, increasing our intake is an easy win.
Let’s look again at that meta-analysis on potassium and blood pressure. When daily potassium intake reached 3,500 to 4,700 mg, the blood pressure reduction was an amazing 7.16 mmHg [8].
The outsized impact of potassium is the reason I include it in my own daily supplement routine. But just because I take a supplement, that in no way means you have to as well.
There’s a second reason why targeting potassium-rich foods is smart. It comes with some impressive additional benefits. That’s because the kinds of foods that have plenty of potassium — like bananas, leafy greens, and legumes — are packed with other nutrients that benefit our health. One of the most significant is fiber.
Shift Two: Increase your fiber intake
Unless you have gut issues like irritable bowel syndrome, most of us should try to increase our fiber intake.
What’s so great about fiber? Well, fiber consumption has been shown to reduce blood pressure. In a recent review drawing on existing studies, the authors conclude each extra 5 g of fiber a day reduces blood pressure by 2.8 mm Hg [9].
Another thing fiber does for us is promote weight loss. It helps in a few key ways.
When we eat fiber-rich foods, the fiber absorbs water in our digestive system. Think of it like a sponge, soaking up liquid and getting larger. This creates a feeling of fullness in our stomach, helping us feel satisfied with less food.
Fiber also slows down digestion. This gradual processing helps maintain steady blood sugar levels rather than sharp spikes and crashes that can trigger hunger.
Finally, high-fiber foods also typically require more chewing. This extended eating time gives our bodies a chance to register fullness before we overeat.
One study measured the cumulative impact with a group of adults who were trying to lose weight. Researchers checked several variables and found one that best predicted how much weight people would lose: fiber. Eating more of it promoted weight loss [10].
But how does losing weight tie back into blood pressure? A meta-analysis looked at the relationship between weight loss and a drop in blood pressure. Those with a BMI drop of more than 3 saw their blood pressure fall by an average of 8.54 mmHg [11].
Shift Three: Increase your lean protein intake
Let’s turn to the last habit shift. It’s also something that helps reduce blood pressure and weight — which compounds its impact. The shift is increasing our lean protein intake.
One large cohort study in England examined the diets of about 1,300 adults over the course of 11 years. The study found that higher protein intakes were associated with lower average blood pressure [12]. And here’s something particularly striking: when those higher protein diets were also higher in fiber, there was a massive 59% reduction in the risk of high blood pressure [12].
What about weight? High-protein diets help us maintain a healthy weight. They make us feel fuller and stimulate the body to burn more calories [13]. And, again, this ultimately helps drive down blood pressure levels.
So while salt substitutes can be helpful, I recommend to my patients to take a broader approach to getting blood pressure under control: Eat more potassium-rich foods, up your fiber intake, and get more lean protein.
Can we do all three at once? Fortunately, yes.
There are some powerhouse foods that are full of potassium, fiber, and protein. There are lots of examples in the legume family. Lentils, chickpeas, and black beans are great choices. Some other foods to target include Brussels sprouts, quinoa, avocados, nuts, and chia seeds.
Reference List
1. https://jamanetwork.com/journals/jamacardiology/article-abstract/2829790
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055199/
3. https://pubmed.ncbi.nlm.nih.gov/24524886/
4. https://journals.physiology.org/doi/full/10.1152/ajpregu.00491.2005
5. https://www.nejm.org/doi/full/10.1056/NEJMoa2105675
6. https://pubmed.ncbi.nlm.nih.gov/39318198/
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC11001572/
8. https://www.bmj.com/content/346/bmj.f1378.long
9. https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.123.22575
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC6768815/
11. https://pmc.ncbi.nlm.nih.gov/articles/PMC10184479/
12. https://pubmed.ncbi.nlm.nih.gov/25194158/
13. https://www.uptodate.com/contents/obesity-in-adults-dietary-therapy
1 comment
Hi Dr. Brad – do you have recommended salt substitute brands?