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Do you need to limit salt or simply use a substitute?

If Joe Graedon were Salt’s defense attorney and used an article he wrote in August as his Exhibit A evidence, the jury’s verdict would have to come back “not guilty.”

While Graedon, who began writing the well-known syndicated newspaper column “The People’s Pharmacy” 43 years ago, doesn’t fully exonerate Salt for the nearly 500,000 deaths each year related to high blood pressure in “The Salt Wars Rage On,” he certainly creates reasonable doubt. He does so by offering evidence that suggests the widely accepted medical belief that 90 percent of people in the U.S. take in too much sodium may very well be wrong.

But I won’t serve as Graedon’s co-council, at least not right now. Instead, I’ll plead a related case, one that I last made here in 2017.

That it’s a lack of potassium in your diet combined with high-sodium ingestion that begets high blood pressure. That getting an ample amount of potassium from your diet from good-for-you sources - such as peas, spinach, squash, broccoli, Brussels sprouts, bananas, potatoes, watermelon, raisins, beans, lentils, chicken breast, and salmon - might be more important than whether or not you adhere to the 2020-2025 Dietary Guidelines for Americans recommendation of ingesting less than 2,300 mg of sodium each day.

And the reason I’m pleading this case again? In the good old USA, stark new evidence gets a convicted murderer a retrial.

Before you read it, however, it helps to know that Salt, aka Sodium Chloride, is a sort of street handle. That his real name is Sodium, and he’s one of the chemical elements found in the salt used to add taste to foods.

The fresh evidence - a meta-analysis of all pertinent studies done as of September 1, 2021 and published in the August 2022 issue of Heart - ultimately focuses on five studies that included more than 24,000 participants. It concludes the use of salt substitutes lowers the risk of death from heart disease or stroke by 11%, the risk of early death from any cause by 11%, and the chance of developing cardiovascular disease of any kind by 13%.

Additionally, the researchers found that regardless of the country or cross-section of its inhabitants, the benefit of salt substitutes on blood pressure was “consistent.”

And the key ingredient in salt substitutes is -yes, you guessed it - potassium in the form of potassium chloride.

This recent meta-analysis supports the review written by Alicia McDonough, Ph.D., professor of cell and neurobiology at the Keck School of Medicine at the University of Southern California and published in the April 2017 issue of the American Journal of Physiology: Endocrinology and Metabolism that lead me to write the column about the sodium/potassium link five years ago. It determined that higher levels of dietary potassium were generally associated with lower blood pressure - regardless of the level of sodium intake.

Subsequently, a paper published in the December 2019 issue of Hypertension, reinforced McDonough’s assessment citing “empirical evidence” that replacing salt with a potassium-enriched salt substitute lowers systolic and diastolic blood pressure, while finding “insufficient evidence” that the use of potassium-enriched salt substitutes increases the occurrence of hyperkalemia, the medical term for when the potassium level in your blood is higher than normal.

There is evidence, though, that your current potassium level is lower than optimal.

Because multiple studies have found people at risk of high blood pressure or stroke could benefit from consuming at least 4,700 mg of potassium per day, the National Institute of Health recommends everyone gets that amount. Yet information culled from a five-year national study and published in the September 2012 issue of the American Journal of Clinical Nutrition found that about 98 percent of adult Americans fall short.

Using a salt-substitute instead of the real thing, in essence, kills the proverbial second bird with a single stone. A single serving of the brand I use not only eliminates 581 mg of sodium from my diet, but also adds 690 mg of potassium to it.

Which leads us back to Joe Graedon’s well-balanced article and the reasonable doubt it creates about the Centers for Disease Control and Prevention current estimate that 90 percent of Americans take in too much sodium.

It does so by bringing forth studies such as the one performed at McMaster University in Hamilton, Ontario and published in the August 11, 2018 issue of The Lancet. It found “sodium intake was associated with cardiovascular disease and strokes only in communities where mean intake was greater than 5 grams per day.”

The current average for American adults is 3,400 mg per day.

In an interview about the study, Andrew Mente, Ph.D. and first author of it, added: “We found all major cardiovascular problems, including death, decreased in communities and countries where there is an increased consumption of potassium.”