A healthier form of salt could prevent millions of deaths from stroke and heart disease
Researchers from The George Institute for Global Health assessed the health benefits of switching the salt supply to potassium-enriched salt across 193 countries. They found almost three million deaths and ten million new cases of cardiovascular and kidney disease could be prevented globally each year.
Bruce Neal, Senior Professorial Fellow at The George Institute said the health gains would be widespread and could avert as many as one in ten cardiovascular deaths in most countries.
“Consuming too much sodium and not enough potassium are well established causes of high blood pressure - a major risk factor for life threatening conditions like strokes, heart attacks and kidney disease. Switching to potassium-enriched salt addresses both these dietary issues at the same time, with substantial health benefits,” he said.
"While a global shift from regular salt to a potassium-enriched substitute is asprational, this is a starting point to get countries thinking about the opportunity - with much greater potential and at mcuh lower cost than many drug-based treatments."
Potassium-enriched salt is made by replacing some of the sodium chloride - which makes up regular table salt - with potassium chloride. It looks, tastes, and cooks like regular salt. In 2025, the World Health Organization (WHO) endorsed the use of potassium-enriched salt to reduce blood pressure and the risk of cardiovascular disease.2
Worldwide, one in three adults aged 30-79 have high blood pressure (hypertension), equivalent to around 1.4 billion people.3 Cardiovascular disease (CVD) is the leading cause of death and disability globally, causing 19.2 million deaths in 2023, an increase of nearly 50 percent over the last 30 years.4
The study examined a range of hypothetical scenarios, from a full global switch of all salt to more targeted use among people with diagnosed and treated high blood pressure. Even the most limited level of switching still showed major health gains.
For the world’s adult population (4.6 billion people):
Extent of switch | Deaths prevented (millions) | CVD and CKD* cases prevented (millions) |
Only regular table salt used in the home | 1.85 | 6.19 |
Only salt in processed and restaurant foods | 1.56 | 5.46 |
Both the above | 2.96 | 10.17 |
*Chronic kidney disease
For 80% of people with diagnosed or treated hypertension only (659 million people diagnosed, 524 million people treated):
Extent of switch | Deaths prevented (millions) | CVD and CKD* cases prevented (millions) |
Only regular table salt used in the home by people with diagnosed hypertension | 0.59 | 1.72 |
Only regular table salt used in the home by people with treated hypertension | 0.48 | 1.41 |
*Chronic kidney disease
While the potential benefits are large, one concern is the risk of high potassium levels (hyperkalaemia) in people with advanced kidney disease. The study found, however, that even among patients with advanced kidney disease the benefits outweighed the risks.
“People with serious kidney disease and those taking medications that significantly raise blood potassium levels need to take precautions. Risks for this group can be managed effectively through patient education, product labelling, and clinical oversight,” said nephrologist Professor Vivek Jha, Senior Professorial Fellow at The George Institute in India.
Professor Neal highlighted the need for country-specific strategies, tailored to whether most sodium intake comes from household salt or processed foods.
“To realise the maximum benefits from switching to potassium-enriched salt, we need to see the food industry in Europe and North America – where over 70% of salt intake comes from processed and restaurant foods – get on board. This would also require investigating ways to scale up the production of potassium chloride to meet demand,” he said.
Estimated annual health impact of replacing all salt with potassium-enriched salt:
Country | Annual deaths prevented | Cases of cardiovascular disease and kidney disease prevented/year | Total fatal and non-fatal events prevented |
China | 1,082,666 | 3,614,123 | 4,696,789 |
India | 399,884 | 1,528,494 | 1,928,378 |
USA | 104,787 | 491,905 | 596,692 |
Mexico | 30,464 | 138,546 | 169,010 |
Nigeria | 18,069 | 59,348 | 77,417 |
United Kingdom | 12,951 | 59,988 | 72,939 |
South Africa | 6,761 | 22,955 | 29,716 |
Australia | 2,076 | 15,674 | 17,750 |
References
- Huang L, et al. The effects on global health outcomes of switching from regular salt to potassium-enriched salt: a modelling study. Nature Health. 2026. https://doi.org/10.1038/s44360-026-00216-9.
- World Health Organization. Use of lower-sodium salt substitutes: WHO guideline. 2025. Available at: https://www.who.int/publications/i/item/9789240105591. Accessed December 2025.
- World Health Organization. Global report on hypertension 2025: high stakes: turning evidence into action. 2025. Available at: https://www.who.int/publications/i/item/9789240115569. Accessed December 2025.
- Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators. Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023. J Am Coll Cardiol. 2025. https://doi.org/10.1016/j.jacc.2025.08.015
Journal
Nature Health
Method of Research
Computational simulation/modeling
Subject of Research
People
Article Title
Global health outcomes from replacing dietary sodium chloride with potassium-enriched salt
Article Publication Date
4-Nov-2026
COI Statement
ES has received speaker honoraria from Servier, Abbott, Sanofi, AstraZeneca, Medtronic, and Omron, and serves on scientific advisory boards for Medtronic, Alnylam, AstraZeneca, SiSU Health and Sky Labs. EJH and TMB has received author royalties from UpToDate. KM, TMB, LJA, and MM received research support from Resolve to Save Lives. LJA reports consulting fee from Give Well and honoraria from Wolters Kluwer, Cardiometabolic Health Congress Symposium, Cardiometabolic Health Congress Symposium and Controversies to Consensus in Diabetes, Obesity and Hypertension (CODHy), outside the submitted work. KM received personal fees from Fukuda Denshi and RhythmX AI outside of the submitted work. MM reports funding from the World Health Organization and consulting fee from GiveWell, outside of the submitted work. No other author has a conflict of interest to declare.
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