Salt substitutes are risky for those with kidney disease

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Re your report in the print edition (Salt substitute cuts risk of heart attack – study, 31 August), it was with great alarm that I read the statement attributed to Prof Bruce Neal that “if you were to replace all of the salt on supermarket shelves with salt substitutes, you would prevent thousands of strokes and heart attacks every year”. According to a report by NHS Kidney Care, “more than 1.8 million people in England have diagnosed chronic kidney disease (CKD). In addition, there are thought to be around a million people who have the condition but are undiagnosed. CKD can substantially reduce quality of life, and leads to premature death for thousands of people each year.”

Most diagnosed kidney patients must strictly limit their intake of potassium as an excess of this element in the body can lead to stroke and sudden heart failure. As the report states, the most ubiquitous substitute for sodium chloride (common salt) is potassium chloride. Therefore, far from preventing strokes and heart attacks, such a widespread substitution could cause many thousands of extra such occurrences among patients with significantly reduced kidney function. As a kidney dialysis patient, I believe that this fact should be made widely known among the public, but particularly among potential policymakers.
John Rippon
Witton Gilbert, County Durham

It is good news that thousands of strokes and heart attacks could be prevented annually in the UK if diners replaced salt with a substitute. But it begs the question why so many of us feel the need to add salt to food in the first place. From my experience, it is a habit often triggered by the presence of a cruet on the dinner table.

Salt is naturally present at low levels in all foods and there is no requirement for more to be added to meals prepared at home. It is essentially a matter of taste – once you became accustomed to vegetables without added salt, you would never add it again. All you would taste is sodium chloride.

The salt substitute used in the study was still 75% sodium chloride. I wonder how many more strokes and heart attacks would be prevented if diners could be persuaded to get out of the habit of adding unnecessary salt (or salt substitute) to their food.
Mike Pender

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