# Effects of low-sodium bread on dietary compliance and fecal cultivable bacteria in a randomized controlled pilot trial in hypertensive subjects

## TL;DR

A low-sodium bread helped reduce sodium intake and blood pressure in hypertensive patients, while also altering gut bacteria.

## Contribution

An innovative low-sodium bread formulation improved dietary compliance and affected fecal bacteria in hypertensive subjects.

## Key findings

- LS bread reduced 24-hour urinary sodium excretion by 908 mg compared to standard bread.
- Diastolic blood pressure decreased by 9 mmHg in patients consuming LS bread.
- LS bread lowered counts of several fecal bacteria like Bacteroides and Enterobacteriaceae.

## Abstract

High salt intake and compliance to low-sodium (LS) diets are critical in hypertension. Salt reduction in processed foods can help to achieve the target sodium intake. To verify the hypothesis that an innovative LS formulation of a traditional bread could result in a reduction of sodium intake and blood pressure, we performed a 6-month randomized controlled pilot trial on hypertensive patients. We additionally explored the effects of sodium restriction on blood pressure and fecal cultivable bacteria.

Fifty-seven patients were randomized in three groups. Group A (n = 19) followed a free diet using standard bread (750 mg Na/100 g), group B (n = 18) followed a LS diet (2300 mg Na/die) using standard bread, group C (n = 20) followed a LS diet (2300 mg Na/die) using LS bread (280 mg Na/100 g). We measured 24-h urinary sodium, blood pressure, routine parameters, fecal microbial counts (26 patients).

After 6 months, as compared to group A, group C showed a reduction of 24-h urinary sodium excretion (-908 mg/24 h), diastolic pressure (-9 mmHg) and microbial counts of Bacteroides, Porphyromonas, Prevotella, Enterobacteriaceae, Staphylococcus, Micrococcus. These results suggest that LS bread could increase the adherence to a LS diet, reducing sodium excretion, diastolic pressure and abundance of some fecal cultivable bacteria.

Trial registration Registration nr. NCT03127553, on 25/04/2017.

The online version contains supplementary material available at 10.1186/s40795-024-00838-w.