Could a simple swap in your salt shaker save millions of lives? Professor Bruce Neal, Senior Professorial Fellow at The George Institute for Global Health, joins us to talk about a new study in Nature Health. It found that switching from regular salt to potassium-enriched salt worldwide could prevent nearly 3 million deaths and 10 million new cases of heart and kidney disease each year.
Jeffrey Snyder, Broadcast Retirement Network
Well, Bruce, it’s so great to see you. Thanks for making time for us this morning, Australia time and Eastern United States time.
Bruce Neal, The George Institute for Global Health
Pleasure. Nice to be here. Thanks, Jeff.
Jeffrey Snyder, Broadcast Retirement Network
It’s great to see you. We’re going to talk about salt this morning, and I want to get into the research you and the Georgia Institute did, but I want to back up for a second because salt, a lot of people put salt on their food or it may be incorporated in their cooking. How does salt have an impact on our bodies and what diseases could it lead to?
Bruce Neal, The George Institute for Global Health
Yeah, so it’s been pretty well established for a long time that if you eat too much salt, so salt’s made of sodium chloride and it’s the sodium bit that’s the bad bit, but if you eat too much of that sodium, what it does is it pushes up your blood pressure and it does that throughout your life and it causes increased risks of strokes, heart attacks, and in fact, high blood pressure is the single most common cause of premature death and disability worldwide.
So it’s a really big health problem.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, it’s a big problem, not only here in the States and in Australia, but it appears to be a huge issue around the globe, no matter what type of diet you have. And I would imagine in Australia and around the globe, just like here in the States, I mean, people are maybe adding a little bit too much to their food, they’re using it in their cooking. I guess it gives flavor.
I don’t add salt to my food, but I would imagine it adds some level of flavor that you believe you need.
Bruce Neal, The George Institute for Global Health
Just to give you a sense of how much we actually need and how much we actually eat, for most of human evolution, in a paleolithic diet, you get about half a gram of sodium a day. Nowadays, average global consumption is about eight times that. So it’s four grams a day.
So you’re not just eating a little bit more, you’re eating a lot more. And it is because people like a salty flavor. And I’ve been working in this space for the best part of 20 years now, trying to get people to cut the amount of salt they eat.
And it just turns out to be really hard, whether they’re individuals or whether they’re food companies, because that salty flavor is absolutely paramount to pretty much everyone.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, it’s interesting. It’s in our self-interest. We’ll talk about the research in a second, switching to potassium-based salt.
But I guess it’s in our self-interest to lower our blood pressure. And yeah, you want to eat things that taste good, but you don’t want to die prematurely. And I think the research shows over time that the more salt you eat, the more sodium you consume, the more your chances for premature death go up.
Bruce Neal, The George Institute for Global Health
Yeah, that’s absolutely right. Interesting that you mentioned potassium there. And I’ll just say a couple of quick words on that.
So potassium is the other major salt that we need for our body. And if we go and go back to human evolution, if we eat a paleolithic diet, we eat a lot of potassium. You get about 10 grams a day.
But with the industrialization of the food system over the last 100 years or so, that’s now dropped down to about a quarter of that level. And that’s important because actually, if you eat too little potassium, that also causes your blood pressure to go up.
Jeffrey Snyder, Broadcast Retirement Network
Okay, thanks for that distinction. And again, I’m a layperson, so I’m not, you’re clearly the one with the skill and the expertise and the scientist here. But so how do we, it sounds like based on the research that if we make a switch, not we, but if people in their own diets or in the manufacturer of food make a switch from sodium to potassium, that could save millions and millions of lives.
Bruce Neal, The George Institute for Global Health
Yeah. So what we’ve done with this research is sort of modeled out the potential impact of moving from this idea of trying to get people to cut the amount of salt they eat because they won’t do it because food tastes different to switching the amount of salt or the type of salt that they eat. And what we’re really talking about is something called potassium enriched salt or a salt substitute or a low sodium salt.
And in that type of salt, what we’ve done is simply taken out some of the sodium chloride that makes up regular salt and put in potassium chloride instead. And if you do that, you get a double benefit because if you eat that potassium enriched salt, you’re consuming less sodium, which lowers your blood pressure. And you’re also consuming more potassium, which also lowers your blood pressure.
And the impact of those things, even if you only switch out a quarter of the sodium chloride is pretty enormous. And what our study showed was if you could switch the entire world’s salt supply, which is pretty ambitious, but it’s a good starting point, then what you do is you would actually prevent about three million people dying each year and you’d prevent another 10 million going to hospital because they’ve had a stroke or heart attack or got serious kidney disease.
Jeffrey Snyder, Broadcast Retirement Network
Yeah. And that means one of the debates we’re having here in the United States is about health care expenses. I think our health care expenses exceed those like three or four times those of other societies around the globe.
This would be a big case in terms of reducing some of those chronic diseases. So I got to ask you, you did the research. How does it taste?
I mean, I probably wouldn’t know the difference, but would someone who is used to applying salt, what does it taste drastically different than the traditional sodium salt that people use on their kitchen table?
Bruce Neal, The George Institute for Global Health
So the salt that we’ve worked with is this 25-75 combination. So it’s still mostly what you’re used to eating sodium chloride. The reason we chose that composition is that if you put a lot of potassium chloride in, if you put 50 percent or two thirds, then what you will find is that people will taste a slightly metallic taste and it will taste a bit different.
At a 25-75 combination, most people don’t taste a difference. And if they do, it’s a pretty small difference. And if they’ve been recommended it by a doctor or because they know it’s good for their health, then they will usually stick with it and accept that slightly different taste because they know that they’re getting a health benefit.
We did one very large study, which we reported a few years ago now. And in that study, we gave 11,000 people potassium enriched salt for five years and more than 90 percent of them were still using the potassium rich salt after five years, which really just speaks to how well accepted it is from a taste perspective.
Jeffrey Snyder, Broadcast Retirement Network
So it’s accepted from a taste perspective, and I would imagine clinicians, people on the front line, the American Heart Association and their comparable affiliates around the globe and American Stroke Association, I’m thinking that they have embraced the research, right? I mean, it’s just another tool in the toolbox, I would think.
Bruce Neal, The George Institute for Global Health
Yeah, absolutely. So one of the key challenges with these types of salts is that most people just haven’t heard of them, to be honest. And so that’s what we’re doing now is research to both prove what they might do, but also to raise their awareness.
The American Heart Association puts out guidelines that provide recommendations to physicians, dieticians about how to help people with hypertension manage their blood pressure. And what we’ve seen in their latest update is them including a specific recommendation that if you have got high blood pressure and you use salt, then you should think hard about switching to potassium enriched salt. And we’re seeing a lot of guidelines starting to change around the world.
And the World Health Organization also launched a guideline making this same recommendation last year.
Jeffrey Snyder, Broadcast Retirement Network
So all that being said, and it sounds like there’s a global consensus, I don’t want to prejudge, but it sounds like people are on board with this, especially if the taste is so, difference is so nominal. How do you get the manufacturers, because we have a movement here in the United States, I think it’s called Make America Healthy Again. People may not like the name, but I think the end goal is to reduce some of these chronic diseases and therefore it’s kind of shaping the recommendations.
So how do you get the, and part of that has been to work with the manufacturers of food to eliminate things like dyes, etc. So how do you get the manufacturers on board? Because I would think again, it’s more in their self-interest to sell people something that tastes comparable is better for them.
I would buy more of that than something that is bad for you, like a bad chip or something like that. But who am I to judge?
Bruce Neal, The George Institute for Global Health
Yeah, so when you come to the food industry, it basically all comes down to price. And one of the key challenges at the moment is that the potassium chloride that you put in, potassium-enriched salt is more expensive to produce than the sodium chloride, which regular salt is currently made up of. So what we’re going to have to do if we want food manufacturers to pick this up at scale is to identify how to get the price of potassium-enriched salt down to the price of regular salt.
Don’t get me wrong, it’s still cheap. You know, most people, if they’re recommended to buy it by a doctor will go to a store and they’ll buy it because, yep, it costs twice as much as regular salt, but regular salt is a very cheap thing. But when you’re a food industry manufacturer and you’re tens or hundreds or even thousands of tons of a product, then the price difference looks like a lot on the spreadsheet.
So what we’re doing is looking at ways of scaling the manufacturer of potassium chloride to bring down the price. And also, interestingly, there are some industries that have potassium chloride as a waste product where it might be able to sort of pick it up, use it as part of a circular economy, and that also could bring the price down because you’re taking a waste product away from a company that would otherwise have to pay to dispose of it.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, it’s kind of like the old aluminum recycling. Maybe that’s a bad analogy, but it’s like, hey, you know, repurpose, shred the Coke can or whatever, the soda can, create something else out of it, and everyone benefits. Society benefits, the manufacturers benefit, and also the environment benefits.
Let me ask you just as a last question, how do you follow up on this? So how do you get, what’s your next step in trying to get this to scale? I mean, does this exist in a natural environment or is it really just a byproduct of production?
So I couldn’t go to like the salt mines in Utah here in the United States and find this type of salt.
Bruce Neal, The George Institute for Global Health
Yeah, so most salt is produced by evaporating seawater and that’s basically sodium chloride. The potassium chloride usually comes from mining a product called potash, which is mostly used for fertilizer in the farming industry. So what you have to do is you have to take that potash and you have to do some additional refining of it to turn it into the potassium chloride you can use in food grade salt.
You can already buy potassium enriched salt products in 60 or 70 countries around the world, you can buy them in the US. The challenge is that they’re not always obvious, they’re usually on the bottom shelf of the supermarket rather than at eye level. You can find them if you search online, but they will also tend to be more expensive.
They won’t be as expensive as some of the fancy salts that people buy these days, but they will be more expensive. So again, it’s really just a matter of raising awareness amongst community, amongst healthcare professionals, so that more people know about them, more people ask for them. That will increase the scale of manufacture, that will bring the price down, and then we’ll start to see the sorts of benefits that we modelled.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, you know, all these things are really in the palm of your hand if you want to do a little bit of research, not much, and take a little bit of control. Bruce, we’re going to have to leave it there. It’s great research.
Thank you so much for getting up a little early, or a lot early in your case, and your day ahead of me, getting up early. We really appreciate it, and we look forward to having you back on the program again very soon, sir.
Bruce Neal, The George Institute for Global Health Thanks, Jeff. It’s been a pleasure
