Salt substitutes may reduce stroke recurrence and death, according to new research.
A study published February 5 in
“This finding shows that salt substitution is a cost-effective option for survivors of stroke by providing considerable health benefits through a simple dietary intervention strategy. It provides direct evidence to shape public health strategies worldwide, especially among populations who rely on home cooking with salt,” the study authors write.
“The effects of reducing dietary sodium and supplementing dietary potassium on lowering blood pressure (BP) have been demonstrated in many randomized clinical trials. Salt substitutes, which replace a portion of sodium chloride with potassium chloride, combine the BP-lowering effects of both reduced dietary sodium and increased dietary potassium,” they concluded.
The present study involved a subgroup analysis of the
This analysis included data from more than 15,000 SSaSS participants with a history of stroke. Researchers analyzed this subgroup data from November 2023 to August 2024.
During the study period, participants were assigned to use either regular salt or a salt substitute containing 75% sodium chloride and 25% potassium chloride.
The researchers found that among those in the salt substitute group, rates of recurrent stroke were significantly lower when compared with the regular salt group. Rates of recurrent stroke were particularly lower for hemorrhagic strokes.
Death rates were also lower in the group that had salt substitutes.
Experts say while the findings aren’t entirely surprising, the research is important.
“I am impressed with the large number of patients involved with the trial and the duration they were followed,” Paul George, MD, PhD, associate professor of neurology and neurological sciences at Stanford, told Healthline. George wasn’t involved in the study.
“To some degree, it has been shown prior to this study the impact salt has on blood pressure, which is a main stroke risk factor, so I wouldn’t say totally surprising. However, the study is important given it is the largest study conducted, looking specifically at the question of the impact of lowering salt in your diet with a substitute and how it affects recurrent stroke and mortality. It provides helpful evidence that this is beneficial in the studied population,” George said.
In the United States, stroke is a
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There are numerous risk factors for stroke, including smoking, obesity, diabetes, high cholesterol, and high blood pressure. Around
Diet, including how much salt a person consumes, is an important risk factor.
For most people, consuming too much salt can lead to high blood pressure.
“High blood pressure, out of all the risk factors for stroke, is the number one modifiable risk factor for stroke,” May Kim-Tenser, MD, medical director of the neuro intensive care unit with Keck Medicine of USC, not involved in the new study, told Healthline.
“If people can control their blood pressure all the time, the risk for stroke is lower, so it’s definitely very important, especially for someone who’s had a stroke before, and for recurrent stroke, is to make sure that their blood pressure is within that normal range.”
Table and sea salts contain about
Salt substitutes replace some of the sodium chloride in salt with potassium chloride. In the JAMA Cardiology study, the salt substitute used contained 75% sodium chloride and 25% potassium chloride.
These salt substitutes can be purchased at a regular grocery store, and can have beneficial impacts on blood pressure levels inside the arteries.
Sodium is an electrolyte that pulls water into cells to help regulate the sodium-water balance in the body. When you consume more sodium, it raises sodium levels in your bloodstream, causing your body to retain more water to maintain balance.
In other words, “water follows salt, and you have more actual water volume in your body when you’re ingesting more sodium,” Jason Tarpley, MD, PhD, board certified vascular neurologist and medical director of the Pacific Stroke and Neurovascular Center at Providence Saint John’s Health Center in Santa Monica, CA, explained. Tarpley wasn’t involved in the study.
“More volume of water in the same amount of blood vessels means higher pressure. So that’s really the link between high sodium intake and blood pressure. It’s related to the fact that sodium draws in water. Potassium doesn’t seem to have the same effect. And that’s the basis of the salt substitutes,” Tarpley told Healthline.
The JAMA Cardiology research follows new guidelines from the World Health Organization on lower sodium substitutes.
The WHO recommends reducing sodium intake to less than two grams daily.
“In this context, using less regular table salt is an important part of an overall sodium reduction strategy. If choosing to use table salt, WHO suggests replacing regular table salt with lower-sodium salt substitutes that contain potassium,” the guidelines state.
The guidelines are intended for the general adult population. Pregnant people, young children, people with kidney impairment, or those with health conditions that could compromise their ability to excrete potassium have different sodium requirements.
Christopher Yi, MD, a board certified vascular surgeon at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, said he advises patients to consider salt substitutes and believes this intervention warrants endorsement. Yi wasn’t involved in the JAMA Cardiology study.
“Given the clear benefits and low cost, salt substitutes should be widely promoted — especially in populations with high stroke prevalence. However, patients with kidney disease should consult their doctors before using potassium-containing substitutes,” Yi told Healthline.
“Elderly patients with a history of cardiovascular disease, stroke, or hypertension would most benefit from salt substitutes. However, younger patients with significant family history of cardiovascular disease would also benefit.”
Salt substitutes may reduce the recurrence of stroke and related death.
The substitutes, which replace a portion of the sodium chloride in salt with potassium chloride, may help reduce stroke by reducing blood pressure.
High blood pressure is the number one modifiable risk factor for stroke. Recent guidelines from the World Health Organization suggest swapping regular table salt for lower-sodium salt substitutes that contain potassium.
