Swapping table salt for potassium-enriched salt could prevent 3 million deaths a year, study finds

If every kitchen, restaurant, and food factory in the world replaced ordinary salt with a potassium-enriched alternative, nearly 3 million deaths and more than 10 million new cases of cardiovascular and kidney disease could be prevented each year — all without requiring anyone to change how much they eat. That is the central finding of a large-scale modeling study published November 4 in Nature Health by researchers at The George Institute for Global Health.

The study modeled what would happen if all 193 countries replaced regular table salt — essentially pure sodium chloride — with a blend of 75% sodium chloride and 25% potassium chloride. Using current blood pressure data by sex, age, and country, the researchers estimated how the shift would change sodium and potassium intake, blood pressure, and ultimately disease risk across the world's 4.6 billion adults.

The headline numbers are large: 2.96 million deaths prevented annually, 10.17 million new cases averted, and 69.43 million disability-adjusted life years saved — representing 14.6% of all deaths, 13.1% of new cases, and 16.5% of disability-adjusted life years currently attributable to cardiovascular disease and chronic kidney disease each year, according to the Nature Health paper. In the United States alone, the researchers estimated nearly 105,000 deaths and about 492,000 new cases could be prevented annually.

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.— Bruce Neal, Senior Professorial Fellow, The George Institute for Global Health

The logic is straightforward biochemistry. Sodium and potassium pull in opposite directions inside the body: sodium causes water retention and raises blood pressure, while potassium helps the kidneys flush sodium out and lower it, according to interventional cardiologist Cheng-Han Chen of MemorialCare Saddleback Medical Center, who was not involved in the study. Potassium-enriched salt exploits that dynamic by cutting sodium intake and boosting potassium simultaneously — two dietary corrections in a single product.

While sodium causes water retention and increased blood pressure, potassium will help the kidneys remove sodium from the body and lower blood pressure.— Cheng-Han Chen, MD, interventional cardiologist and medical director, Structural Heart Program, MemorialCare Saddleback Medical Center

The study tested five scenarios, not just a full global switch. Even the most limited — replacing only the discretionary salt used by people already diagnosed with high blood pressure — would still prevent 590,000 deaths a year. Replacing all discretionary salt used at home (1.85 million deaths averted) would prevent more deaths than replacing only the salt in processed and restaurant foods (1.56 million), though both matter. In Europe and North America, where processed and restaurant foods account for more than 70% of salt intake, the researchers said that participation by the food industry is critical to achieving the greatest possible benefit.

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.— Bruce Neal, Senior Professorial Fellow, The George Institute for Global Health

The findings are not purely theoretical. Liping Huang, a senior data analyst in the Food Policy Division at The George Institute and co-lead author of the study, was part of the research team behind an earlier clinical trial spanning roughly 21,000 participants across 600 rural villages in northern China. Participants in that 2021 Salt Substitute and Stroke Study, whose results appeared in The New England Journal of Medicine, showed a 14% reduced stroke risk, a 13% lower rate of cardiovascular events, and a 12% lower chance of early death when using potassium-enriched salt rather than regular salt, according to Healthline. The new study builds those real-world effect sizes into its global projections.

It's really hard for people to cut back their salt intake. But the easier way is just to replace part of the sodium chloride in our normal salt with potassium chloride, because increasing potassium intake also helps to reduce blood pressure.— Liping Huang, PhD, senior data analyst, Food Policy Division, The George Institute for Global Health

Huang also noted that for most people, potassium-enriched salt is virtually indistinguishable from ordinary table salt in flavor, with only those who have a particularly sensitive palate likely to detect any difference. Kosher salt and sea salt, she said, may carry health halos but are still primarily sodium chloride and do not offer the same benefit.

The World Health Organization endorsed potassium-enriched salt in a 2025 guideline, citing its ability to reduce blood pressure and cardiovascular disease risk. Potassium-based salt substitutes are capable of lowering blood pressure in certain adults, the American Heart Association has said. The FDA issued labeling guidance in 2020 allowing potassium chloride to be listed on ingredient labels using the word 'salt.' Potassium-enriched salt can be found at major U.S. grocery chains including Kroger, Walmart, and Publix, though the product generally carries a price tag roughly double that of regular salt, according to the study.

There is one significant caveat: people with advanced chronic kidney disease. In patients whose kidneys are not working properly, excess potassium may build up in the body rather than being cleared, a condition called hyperkalemia — abnormally elevated blood potassium — that can increase the risk of cardiac arrest. According to the researchers' estimates, a complete global switch to potassium-enriched salt could lead to approximately 100,000 deaths per year from hyperkalemia among people with stage 3 to stage 5 kidney disease. But it would also prevent about 750,000 deaths a year by lowering blood pressure in that same group — a net benefit, though one that requires careful management.

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.— Professor Vivek Jha, nephrologist and Senior Professorial Fellow, The George Institute in India

The researchers are candid about the model's limits. It relies on data from several years ago and rests on many assumptions; any large-scale real-world switch would take years to implement. Neal framed the study as a starting point rather than a blueprint, noting the potential is 'much greater and at much lower cost than many drug-based treatments' — but that country-specific strategies are needed, particularly around whether most sodium in a given country comes from home cooking or from processed food.

While a global shift from regular salt to a potassium-enriched substitute is aspirational, this is a starting point to get countries thinking about the opportunity — with much greater potential and at much lower cost than many drug-based treatments.— Bruce Neal, Senior Professorial Fellow, The George Institute for Global Health

Why it matters — Cardiovascular disease kills nearly 20 million people a year globally, and this study suggests a widely available, inexpensive product already on supermarket shelves could prevent a meaningful share of those deaths — with few behavioral changes required.

Reported by eurekalert.org, nature.com, healthline.com