Dietary sodium reduction through salt substitutes and enhancers: Types, applications and health implications

Alvina Rose

Authors

Alvina Rose R&D Associate, Novel Nutrilab, Teresian Innovation and Business Incubation Council (TIBIC), St. Teresa’s College, Ernakulam, Kerala, India

Keywords:

Sodium chloride, cardiovascular diseases, hypertension, salt substitutes, salt enhancers

Abstract

Sodium chloride (NaCl), commonly known as table salt, is an essential ingredient in the food industry that enhances flavor, creates texture and preserves food. On the other hand, consuming too much salt has been connected to several health problems, such as cardiovascular diseases, hypertension, bone demineralization and gastric cancers. Additionally, potential drawbacks related to impaired kidney function should be noted, particularly for individuals with chronic kidney disease (CKD), as reduced renal filtration capacity can worsen electrolyte imbalance and increase the health risks associated with certain salt substitutes. With customers' growing awareness of nutrition and health issues, low-sodium food items are becoming more and more popular. This review explores various approaches to reducing sodium in foods through salt-replacement and enhancement strategies while maintaining desirable sensory and functional properties. A comprehensive review of existing studies was conducted to identify different salt substitutes and salt enhancers. Numerous sodium substitutes, such as potassium chloride, calcium chloride, magnesium chloride and magnesium sulfate, have been assessed for their sensory qualities and functional roles. Additionally, natural and chemical flavor enhancers were examined for their ability to compensate for the reduced saltiness perception. Among the evaluated substitutes, potassium chloride and calcium chloride were the most widely used salt replacers. Major research gaps include limited long-term toxicological evaluations, inconsistent sensory outcomes across matrices and insufficient studies on synergistic combinations of substitutes and enhancers. This review emphasizes that integrating partial mineral substitution with natural flavor enhancement is the most effective approach for developing healthier food products without compromising quality.

References

Albarracín, W., Sánchez, I. C., Grau, R., & Barat, J. M. (2011). Salt in food processing; usage and reduction: A review. International Journal of Food Science & Technology, 46(7), 1329–1336. https://doi.org/10.1111/j.1365-2621.2010.02492.x

Alim, A., Yang, C., Song, H., Liu, Y., Zou, T., Zhang, Y., & Zhang, S. (2019). The behavior of umami components in thermally treated yeast extract. Food Research International, 120, 534–543. https://doi.org/10.1016/j.foodres.2018.11.002

Alino, M., Grau, R., Toldrá, F., Blesa, E., Pagán, M. J., & Barat, J. M. (2010). Physicochemical properties and microbiology of dry-cured loins obtained by partial sodium replacement with potassium, calcium and magnesium. Meat Science, 85(3), 580–588. https://doi.org/10.1016/j.meatsci.2010.03.009

Aprilia, G. H. S., & Kim, H. S. (2022). Development of strategies to manufacture low-salt meat products–a review. Journal of Animal Science and Technology, 64(2), 218–234. https://doi.org/10.5187/jast.2022.e16

Arganosa, G. C., & Marriott, N. G. (1990). Salt substitutes in canned luncheon meat. Journal of Muscle Foods, 1(3), 207–216. https://doi.org/10.1111/j.1745-4573.1990.tb00365.x

Aronson, J. K. (Ed.). (2015). Meyler’s side effects of drugs: The international encyclopedia of adverse drug reactions and interactions (16th ed.). Elsevier Science.

Barido, F. H., & Lee, S. K. (2021). Different effect of sodium chloride replacement with calcium chloride on proteolytic enzyme activities and quality characteristics of spent hen samgyetang. Food Science of Animal Resources, 41(5), 869–882. https://doi.org/10.5851/kosfa.2021.e43

Belasco, W. J. (2008). Food: The key concepts. Berg Publishers.

Brandsma, I. (2006). Reducing sodium: A European perspective. Food Technology, 60(3), 24–29.

Cáceres, E., García, M. L., & Selgas, M. D. (2006). Design of a new cooked meat sausage enriched with calcium. Meat Science, 73(2), 368–377. https://doi.org/10.1016/j.meatsci.2005.12.016

Carreon, R. E., Yano, B. L., & New, M. A. (1981). Peladow calcium chloride (94–97%): Acute toxicological properties and industrial handling hazards (Unpublished Dow Chemical Company report).

Cepanec, K., Vugrinec, S., Cvetković, T., & Ranilović, J. (2017). Potassium chloride-based salt substitutes: A critical review with a focus on the patent literature. Comprehensive Reviews in Food Science and Food Safety, 16(5), 881–894. https://doi.org/10.1111/1541-4337.12291

Clapp, J. (2020). Food (3rd ed.). John Wiley & Sons Ltd.

Dötsch, M., Busch, J., Batenburg, M., Liem, G., Tareilus, E., Mueller, R., & Meijer, G. (2009). Strategies to reduce sodium consumption: A food industry perspective. Critical Reviews in Food Science and Nutrition, 49(10), 841–851. https://doi.org/10.1080/10408390903044297

Doyle, M. E., & Glass, K. A. (2010). Sodium reduction and its effect on food safety, food quality, and human health. Comprehensive Reviews in Food Science and Food Safety, 9(1), 44–56. https://doi.org/10.1111/j.1541-4337.2009.00096.x

Elias, M., Laranjo, M., Agulheiro-Santos, A. C., & Potes, M. E. (2020). The role of salt on food and human health. In M. Çinku & S. Karabulut (Eds.), Salt in the Earth (Vol. 19). IntechOpen. https://doi.org/10.5772/intechopen.86905

Farrand, C., MacGregor, G., Campbell, N. R. C., & Webster, J. (2019). Potential use of salt substitutes to reduce blood pressure. The Journal of Clinical Hypertension, 21(3), 350–354. https://doi.org/10.1111/jch.13482

Feldman, S. R. (2000). Sodium chloride. In Kirk-Othmer Encyclopedia of Chemical Technology (pp. 1–27). John Wiley & Sons. https://doi.org/10.1002/0471238961.1915040902051820.a01.pub2

Fernstrom, J. D. (2007). Health issues relating to monosodium glutamate use in the diet. In D. Kilcast & F. Angus (Eds.), Reducing salt in foods: Practical strategies (pp. 55–76). Woodhead Publishing. https://doi.org/10.1533/9781845693046.1.55

Gilleran, G., O’Leary, M., Bartlett, W. A., Vinall, H., Jones, A. F., & Dodson, P. M. (1996). Effects of dietary sodium substitution with potassium and magnesium in hypertensive type II diabetics: A randomised blind controlled parallel study. Journal of Human Hypertension, 10(8), 517–521.

Grummer, J., Bobowski, N., Karalus, M., Vickers, Z., & Schoenfuss, T. (2013). Use of potassium chloride and ﬂavor enhancers in low sodium Cheddar cheese. Journal of Dairy Science, 96(3), 1401–1418. https://doi.org/10.3168/jds.2012-6057

Hanlon, L. W., Romaine, M., III, Gilroy, F. J., & Deitrick, J. E. (1949). Lithium chloride as a substitute for sodium chloride in the diet: Observations on its toxicity. Journal of the American Medical Association, 139(11), 688–692. https://doi.org/10.1001/jama.1949.02900280004002

Henney, J. E., Taylor, C. L., Boon, C. S., & Institute of Medicine (US) Committee on Strategies to Reduce Sodium Intake. (2010). Preservation and physical property roles of sodium in foods. In Strategies to reduce sodium intake in the United States (pp. 96–101). National Academies Press (US). https://doi.org/10.17226/12818

Horita, C. N., Morgano, M. A., Celeghini, R. M. S., & Pollonio, M. A. R. (2011). Physico-chemical and sensory properties of reduced-fat mortadella prepared with blends of calcium, magnesium and potassium chloride as partial substitutes for sodium chloride. Meat Science, 89(4), 426–433. https://doi.org/10.1016/j.meatsci.2011.05.010

Hou, Y., Li, Z., Zheng, Y., & Jin, P. (2021). Effects of CaCl₂ treatment alleviates chilling injury of loquat fruit (Eriobotrya japonica) by modulating ROS homeostasis. Foods, 10(7), 1662. https://doi.org/10.3390/foods10071662

Jarunrattanasri, A., Theerakulkait, C., & Cadwallader, K. R. (2007). Aroma components of acid-hydrolyzed vegetable protein made by partial hydrolysis of rice bran protein. Journal of Agricultural and Food Chemistry, 55(8), 3044–3050. https://doi.org/10.1021/jf0631474

Jeon, S. Y., Lee, Y. M., Kim, S. S., & Kim, K. O. (2020). Effect of added hydrolyzed vegetable proteins on consumers’ response for Doenjang (Korean traditional fermented soybean paste) soup. Food Science and Biotechnology, 29(1), 45–53. https://doi.org/10.1007/s10068-019-00646-0

Kilcast, D., & Angus, F. (Eds.). (2007). Reducing salt in foods: Practical strategies. Woodhead Publishing/Elsevier.

Kilcast, D., & den Ridder, C. (2007). Sensory issues in reducing salt in food products. In Reducing salt in foods: Practical strategies (pp. 201–220). Woodhead Publishing/Elsevier. https://doi.org/10.1533/9781845693046.2.201

Koopman, T. S. M., & Pot, T. E. (1986). Acute oral toxicity study with anhydrous calcium chloride in male rabbits (Duphar Report No. 56645/52/86, p. 86). Duphar.

Li, X., Cao, C., Yuan, D., Liu, Q., & Zhao, J. (2022). Effects of the incorporation of calcium chloride on the physical and oxidative stability of flled hydrogel particles. Foods, 11(3), 278. https://doi.org/10.3390/foods11030278

Liu, Y., Chen, J., Zou, B., Sun, Y., Zhao, Y., Duan, M., Wang, Y., Dai, R., Li, X., & Jia, F. (2022). Evaluation of the quality and ﬂavor of salted duck eggs with partial replacement of NaCl by non-sodium metal salts. LWT - Food Science and Technology, 172, 114206. https://doi.org/10.1016/j.lwt.2022.114206

Luo, Q., Ding, R., Chen, L., Bu, X., Xiao, M., Liu, X., Wu, Y., Xu, J., Tang, W., Qiu, J., Ding, X., & Tang, X. (2022). The association between spicy food intake and risk of hyperuricemia among Chinese adults. Frontiers in Public Health, 10, 919347. https://doi.org/10.3389/fpubh.2022.919347

Mahdi, Z. A., Al-Khatib, A. M., & Fneich, B. N. (2020). Replacement of sodium chloride by potassium chloride in Armenian cucumber Cucumis melo var. ﬂexuosu pickles: Sensory and microbiological evaluation. Middle East Journal of Applied Sciences, 10(4), 755–761. https://doi.org/10.36632/mejas/2020.10.4.66

Muchaamba, F., Stoffers, H., Blase, R., von Ah, U., & Tasara, T. (2021). Potassium lactate as a strategy for sodium content reduction without compromising salt-associated antimicrobial activity in salami. Foods, 10(1), 114. https://doi.org/10.3390/foods10010114

Norris, J. M. (1971). Eye and skin irritation properties of LIQUIDOW liquid calcium chloride (Unpublished Dow Chemical Company report).

Pashaei, M., Zare, L., Khalili Sadrabad, E., Hosseini Sharif Abad, A., Mollakhalili-Meybodi, N., & Abedi, A. S. (2021). The impacts of salt reduction strategies on technological characteristics of wheat bread: A review. Journal of Food Science and Technology, 59(11), 4141–4151. https://doi.org/10.1007/s13197-021-05263-6

Pateiro, M., Munekata, P. E. S., Cittadini, A., Domínguez, R., & Lorenzo, J. M. (2021). Metallic-based salt substitutes to reduce sodium content in meat products. Current Opinion in Food Science, 38, 21–31. https://doi.org/10.1016/j.cofs.2020.10.029

Rocha, R. A. R., Ribeiro, M. N., Silva, G. A., Rocha, L. C. R., Pinheiro, A. C. M., Nunes, C. A., & Carneiro, J. D. D. S. (2020). Temporal profle of ﬂavor enhancers MAG, MSG, GMP, and IMP, and their ability to enhance salty taste, in different reductions of sodium chloride. Journal of Food Science, 85(5), 1565–1575. https://doi.org/10.1111/1750-3841.15121

Rodrigues, M. J., Ho, P., López-Caballero, M. E., Bandarra, N. M., & Nunes, M. L. (2005). Chemical, microbiological, and sensory quality of cod products salted in different brines. Journal of Food Science, 70(1), M1–M6. https://doi.org/10.1111/j.1365-2621.2005.tb09039.x

Rosa, A., Loy, F., Pinna, I., & Masala, C. (2022a). Role of aromatic herbs and spices in salty perception of patients with hyposmia. Nutrients, 14(23), 4976. https://doi.org/10.3390/nu14234976

Rosa, A., Pinna, I., Piras, A., Porcedda, S., & Masala, C. (2022b). Flavoring of sea salt with Mediterranean aromatic plants affects salty taste perception. Journal of the Science of Food and Agriculture, 102(13), 6005–6013. https://doi.org/10.1002/jsfa.11953

Scopp, A. L. (1991). MSG and hydrolyzed vegetable protein induced headache: review and case studies. Headache: The Journal of Head and Face Pain, 31(2), 107–110. https://doi.org/10.1111/j.1526-4610.1991.hed3102107.x

Sezer, B., Velioglu, H. M., Bilge, G., Berkkan, A., Ozdinc, N., Tamer, U., & Boyaci, I. H. (2018). Detection and quantifcation of a toxic salt substitute (LiCl) by using laser induced breakdown spectroscopy (LIBS). Meat Science, 135, 123–128. https://doi.org/10.1016/j.meatsci.2017.09.010

Shan, Y., Pu, D., Zhang, J., Zhang, L., Huang, Y., Li, P., Xiong, J., Li, K., & Zhang, Y. (2022). Decoding of the saltiness enhancement taste peptides from the yeast extract and molecular docking to the taste receptor T1R1/T1R3. Journal of Agricultural and Food Chemistry, 70(47), 14898–14906. https://doi.org/10.1021/acs.jafc.2c06237

Sharma, M., Gupta, A., & Prasad, R. (2017). A review on herbs, spices and functional food used in diseases. International Journal of Research & Review, 4(1), 103–108.

Sun, C., Zhou, X., Hu, Z., Lu, W., Zhao, Y., & Fang, Y. (2021). Food and salt structure design for salt reducing. Innovative Food Science & Emerging Technologies, 67, 102570. https://doi.org/10.1016/j.ifset.2020.102570

Taladrid, D., Laguna, L., Bartolomé, B., & Moreno-Arribas, M. V. (2020). Plantderived seasonings as sodium salt replacers in food. Trends in Food Science & Technology, 99, 194–202. https://doi.org/10.1016/j.tifs.2020.03.002

Tao, Z., Yuan, H., Liu, M., Liu, Q., Zhang, S., Liu, H., Jiang, Y., Huang, D., & Wang, T. (2023). Yeast extract: Characteristics, production, applications and future perspectives. Journal of Microbiology and Biotechnology, 33(2), 151–166. https://doi.org/10.4014/jmb.2207.07057

Tsugane, S. (2005). Salt, salted food intake, and risk of gastric cancer: Epidemiologic evidence. Cancer Science, 96(1), 1–6. https://doi.org/10.1111/j.1349-7006.2005.00006.x

Yang, Y., Chen, Q., Shen, C., Zhang, S., Gan, Z., Hu, R., Zhao, J., & Ni, Y. (2013). Evaluation of monosodium glutamate, disodium inosinate and guanylate umami taste by an electronic tongue. Journal of Food Engineering, 116(3), 627–632. https://doi.org/10.1016/j.jfoodeng.2012.12.042

Yu, N., Gong, H., Yuan, H., Bao, Y., & Wang, W. (2022). Effects of calcium chloride as a salt substitute on physicochemical and 3D printing properties of silver carp surimi gels. CyTA – Journal of Food, 20(1), 1–12. https://doi.org/10.1080/19476337.2021.2008510