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A Look at Salt Substitutes

      In the course of low-sodium diet education, questions about salt shaker use, sea salt use, and salt substitutes use consistently arise. An April 2011 American Heart Association survey indicates that Americans continue to be confused about sources of sodium in foods, believing that ordinary table salt is the primary sodium source in the diet, and that sea salt has less sodium than table salt. The survey found that 70% of Americans are unaware of the American Heart Association’s recommendation to consume no more than 1,500 mg of sodium per day.

      American Heart Association [news release]. Available at: http://newsroom.heart.org/pr/aha/1316.aspx.

      The 2010 Dietary Guidelines for Americans recommend a 2,300 mg sodium limit for Americans, but 1,500 mg of sodium per day for individuals aged >51 years, African Americans of any age, diabetics, hypertensives, and those with chronic kidney disease; these key risk groups comprise half of the U.S. population.

      Dietary Guidelines for Americans, 2010. Available at: health.gov/dietaryguidelines/2010.asp.

      Complicating the matter further is a highly criticized study published in the May 4, 2011 issue of the Journal of the American Medical Association, indicating a low-sodium diet may increase the risk of death from heart attacks and strokes.
      • Stolarz-Skrzypek K.
      • Kuznwtsova T.
      • Thijs L.
      • et al.
      Fatal and nonfatal outcomes, incidence of hypertension, and BP changes in relation to urinary sodium excretion.
      Indeed, researchers have yet to conclusively link a high-sodium diet and death from cardiovascular disease. Despite this debate, it remains clear that renal patients require a low-sodium diet.
      The National Salt Reduction Initiative, rolled out in January 2011, is a New York City-led proposal aimed at urging food manufacturers to voluntarily reduce sodium in 62 categories of packaged foods and 25 categories of foods sold in restaurants by 25% by 5 years.

      The National Salt Reduction Initiative, 2010. Available at: http://www.nyc.gov/html/doh/html/cardio/cardio-salt-initiative.shtml.

      It has been met with resistance in the food industry, which claimed that lower sodium items simply did not meet consumers’ expectations for flavor, and require costlier ingredients to replace sodium. But many companies, including Kraft Foods and Campbell’s Soup Company, have signed on to the measure as the initiative unfolds.
      Renal dietitians are well aware of the risks of a high-sodium diet in the chronic kidney disease population: dietary sodium intake is associated with greater kidney function decline, and its effects on hypertension and proteinuria are well known. Patients who eat home-cooked foods and fresh foods have the best chances of complying with the 1,500 mg sodium guidelines, and seek low-sodium ways to season their meals. Because of the inappropriate potassium content of most commercially available salt substitutes, patients are often steered toward seasoning blends rather than salt (Table 1). However, many patients voice distaste for seasoning blends, as these products change the flavor of the food rather than mimicking the flavor of salt. An ideal salt substitute for the CKD population is that which has low sodium, is potassium-free, and mimics the flavor of salt.
      • No Salt
      • Reckitt Benckiser North America
      • Morris Corporate Center IV
      • 399 Interpace Parkway
      • P O Box 225
      • Parsippany, NJ 07054-0225
      • Tel: 1-800-228-4722
      • Nu-Salt
      • Cumberland Packing Corp
      • 2 Cumberland Street
      • Brooklyn, NC 11205
      • no phone number listed
      • Morton Salt Consumer Products
      • 123 North Wacker Drive
      • Chicago, IL 60606-1743
      • Tel: 1-800-725-8847
      • Cardia Salt Alternative
      • Nutrition 21, Inc.
      • 4 Manhattanville Road
      • Purchase, NY 10577
      • Tel: 914-701-4500
      • AlsoSalt
      • P O Box 953
      • Maple Valley, WA 98038
      • Tel: 425-432-4300
      • Pleasoning Gourmet Seasonings
      • Frank J. Italiano, Inc.
      • 2418 South Avenue
      • P O Box 2701
      • La Crosse, WI 54602
      • Tel: 1-800-279-1614
      • Salt Sense
      • Diamond Crystal Brands
      • 3000 Tremont Road
      • Savannah, GA 31405-1500
      • Tel: 912-651-51112
      • Mrs. Dash
      • Alberto-Culver Company
      • 2525 Armitage Avenue
      • Melrose Park, IL 60160
      • Tel: 708-450-3000
      • Spike Salt-Free Seasoning
      • Modern Products, Inc.
      • 6425 West Executive Drive
      • Mequon, WI 53092
      • Tel: 262-242-2400
      • Jane’s Crazy Mixed-Up Seasonings
      • 250 Old Marlton Pike
      • Medford, NJ 08055
      • Tel: 609-654-7901
      • Old Bay Seasoning
      • McCormick & Company, Inc.
      • 211 Schilling Circle
      • Hunt Valley, MD 21031
      • Tel: 800-632-5847
      Table 1Salt Substitutes
      AmountSodiumPotassiumMagnesiumCalciumPhosphorus
      Salt substitutes containing potassium chloride
       No Salt1/4 teaspoon0 mg650 mg0 mg0 mg0 mg
       Nu-Salt1/4 teaspoon0 mg780 mg0 mg0 mg0 mg
       Morton’s Salt Substitute1/4 teaspoon0 mg610 mg<1 mg7 mg5 mg
       Morton’s Lite Salt1/4 teaspoon290 mg350 mg2 mg0 mg0 mg
       Morton’s Salt Balance Salt Blend1/4 teaspoon440 mg200 mg<1 mg0 mg0 mg
       Cardia Salt Alternative1/4 teaspoon270 mg180 mg13 mg0 mg0 mg
       AlsoSalt1/4 teaspoon0 mg356 mg0 mg0 mg0 mg
       Mrs. Dash1/4 teaspoon0 mg5-15 mg0 mg0 mg0 mg
       Salt-Free Spike1/4 teaspoon2 mg24 mg0 mg0 mg0 mg
      Salt substitutes containing no potassium chloride
       Pleasoning Mini-Mini1/4 teaspoon110 mg0 mg0 mg0 mg0 mg
       Salt Sense1/4 teaspoon390 mg0 mg0 mg0 mg0 mg
       Jane’s Crazy Mixed-Up Salt, original1/4 teaspoon240 mg0 mg0 mg0 mg0 mg
       Old Bay Seasoning1/4 teaspoon160 mg0 mg0 mg0 mg0 mg
       Morton’s Seasoning Salt1/4 teaspoon350 mg0 mg0 mg0 mg0 mg

      References

      1. American Heart Association [news release]. Available at: http://newsroom.heart.org/pr/aha/1316.aspx.

      2. Dietary Guidelines for Americans, 2010. Available at: health.gov/dietaryguidelines/2010.asp.

        • Stolarz-Skrzypek K.
        • Kuznwtsova T.
        • Thijs L.
        • et al.
        Fatal and nonfatal outcomes, incidence of hypertension, and BP changes in relation to urinary sodium excretion.
        JAMA. 2011; 305: 1777-1785
      3. The National Salt Reduction Initiative, 2010. Available at: http://www.nyc.gov/html/doh/html/cardio/cardio-salt-initiative.shtml.

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