Potassium-Enriched Salt Could Prevent Millions

How could changing salt prevent millions of deaths?

A study reported on November 4 by the George Institute for Global Health examined hypothetical salt-replacement strategies across 193 countries. Its broadest scenario covered salt added at home and salt used in processed and restaurant foods. Researchers estimated that this could prevent approximately 2.96 million deaths annually, alongside substantial reductions in cardiovascular and chronic kidney disease. The institute identified the research as a modeling study published in Nature Health. [George Institute research announcement](https://www.georgeinstitute.org/news-and-media/news/a-healthier-form-of-salt-could-prevent-millions-of-deaths-from-stroke-and-heart-disease).

These estimates describe potential benefits under modeled conditions; they are not deaths already prevented by an intervention. Actual results would depend on adoption, product composition, food-industry participation and appropriate safeguards. The biological rationale is established: reducing sodium and increasing potassium can help lower blood pressure, an important driver of stroke and heart disease. [WHO guideline launch](https://www.who.int/news-room/events/detail/2025/01/27/default-calendar/launch-of-the-who-guideline-on-the-use-of-lower-sodium-salt-substitutes).

Do clinical trials show that salt substitutes prevent strokes?

The Salt Substitute and Stroke Study, published in the New England Journal of Medicine in 2021, enrolled 20,995 adults across 600 rural Chinese villages. Participants had a previous stroke or were at least 60 years old with high blood pressure. Villages received either regular salt or a mixture containing 75% sodium chloride and 25% potassium chloride. Over approximately five years, the substitute group had a 14% lower relative rate of stroke. That figure describes a relative difference between groups, not a 14-percentage-point reduction in an individual's risk. [Trial publication](https://www.nejm.org/doi/full/10.1056/NEJMoa2105675).

This provides direct evidence of clinical benefit beyond a change in blood-pressure measurements. However, participants were generally at high cardiovascular risk, and household salt use was important in this setting. The benefit cannot automatically be assumed identical in younger populations or different food environments. People reporting serious kidney disease or certain potassium-raising treatments were excluded, limiting what the trial establishes about safety for those groups. [Trial findings and limitations](https://www.nejm.org/doi/full/10.1056/NEJMoa2105675).

Who should seek medical advice before using potassium-enriched salt?

Potassium can accumulate when the body cannot eliminate it adequately, causing hyperkalemia. WHO's recommendation excludes people with kidney impairment or other circumstances that compromise potassium excretion, including use of potassium-sparing diuretics or potassium supplements. Its recommendation also does not extend to pregnant women or children because evidence was insufficient to establish an appropriate recommendation for these groups. [WHO recommendation scope](https://www.ncbi.nlm.nih.gov/sites/books/NBK612027/).

For eligible adults who use table salt, WHO conditionally recommends a potassium-containing, lower-sodium alternative. This remains part of an overall sodium-reduction strategy. Adults should aim for less than 2,000 mg of sodium daily, equivalent to less than 5 g of salt from all sources. Choosing a substitute does not justify adding larger quantities, and household changes alone do not address sodium already present in packaged meals or restaurant food. [WHO sodium guidance](https://www.who.int/news-room/fact-sheets/detail/sodium-reduction).