A study from The George Institute for Global Health found that a healthier form of salt could help prevent millions of cases and deaths from cardiovascular and kidney disease globally per year.
The researchers studied the effect of potassium-enriched salt in 193 countries.
According to them, potassium-enriched salt could be the solution to preventing around one in 10 deaths from cardiovascular diseases per year globally.
Researchers from The George Institute for Global Health, which is headquartered in Australia, recently conducted a study asking: What would happen if we replaced sodium chloride — our standard table salt — with a healthier type of salt, enriched with potassium, an essential macromineral?
In particular, they wanted to see the effect of this substitution on the incidence of kidney and cardiovascular disease and death.
The findings — reported in Nature Health — suggest that switching to potassium-enriched table salt could have a massive positive impact on global heart and kidney health, preventing around one in 10 deaths caused by cardiovascular disease globally each year.
Speaking to Medical News Today, first author Liping (Polly) Huang, PhD, Senior Data Analyst at the Food Policy Division of the George Institute for Global Health, explained the reasoning behind the study.
“Both high sodium intake and low potassium intake increase blood pressure, which is a major risk factor for both kidney disease and cardiovascular disease,” Huang told us. “Unfortunately, the modern diet tends to be high in sodium and low in potassium.”
“For decades, public health efforts around the world have focused on reducing sodium intake, but progress has been slow because people are accustomed to the taste of salt. Researchers […] have looked for practical, scalable alternatives that could improve diets without requiring people to dramatically change their eating habits. Potassium-enriched salt emerged as a particularly promising solution. The evidence supporting this approach is also very strong.”
— Liping (Polly) Huang, PhD
Potassium-enriched salt is obtained by replacing some of the sodium chloride in regular table salt with potassium chloride, which has been linked to better blood pressure control a lower risk of cardiovascular disease.
“Many clinical trials have shown that potassium-enriched salt lowers blood pressure. Most notably, our Salt Substitute and Stroke Study (SSaSS), conducted in rural China between 2013 and 2020, found that replacing regular salt with potassium-enriched salt reduced the risk of stroke by 14%, major cardiovascular events by 13%, and all-cause mortality by 12%,” Huang told MNT.
Importantly, adding potassium does not alter the taste of the salt, making it a more palatable option for people looking to make their diets healthier without giving up on this traditional condiment altogether.
Furthermore, “while it costs slightly more than regular salt, it remains affordable as an everyday product,” said Huang.
In the current study, the researchers looked at data from 193 countries, with the aim of outlining the projected benefits of making the switch from regular salt to potassium-enriched salt following a range different scenarios.
These scenarios were:
making the switch globally both at home and in marketplace products and restaurant meals
making the switch globally just at home, in the context of individual and family meals
making the switch globally just in marketplace products
making the switch globally but just in the case of people with diagnosed hypertension (high blood pressure), both treated and untreated
making the switch globally but just in the case of people receiving treatment for hypertension.
The researchers estimated that, at the global level, making the switch to potassium-enriched salt in home cooking only could prevent 6.19 million cases of chronic kidney disease and cardiovascular disease, and avert 1.85 million deaths from these causes on a yearly basis.
Making this switch in restaurant meals and marketplace products only could prevent 5.46 million cases of chronic kidney disease and cardiovascular disease, and avert 1.56 million deaths.
And making this switch globally both at home and in purchased food products could avert as many as 10.17 million cases of cardiovascular and kidney disease, and avert 2.96 million deaths from these causes.
In populations with diagnosed hypertension specifically, whether treated or untreated, switching to potassium-enriched salt could prevent 1.72 million cases of cardiovascular and kidney disease globally per year, and more than half a million deaths.
Finally, in populations undergoing hypertension treatment, the switch could prevent 1.41 million cases of cardiovascular and kidney disease, and almost half a million deaths from these causes.
These findings apply to adult populations.
Given these projections, Huang told us that:
“The people most likely to benefit are those at higher risk of kidney disease and cardiovascular disease, particularly individuals with high blood pressure and those who consume a lot of salt. Because potassium-enriched salt reduces sodium intake while increasing potassium intake, it can meaningfully lower blood pressure and, in turn, reduce the risk of serious health outcomes.”
“However,” she added, “the benefits are not limited to people with high blood pressure. Blood pressure naturally tends to increase with age, and high salt intake is one of the key drivers of this rise.”
“Reducing sodium intake and increasing potassium intake earlier in life may help slow this rise in blood pressure and support better long-term cardiovascular and kidney health,” she suggested.
Speaking to MNT, Michelle Routhenstein, MS, RD, CDCES, CDN, preventive cardiology dietitian at EntirelyNourished, who was not involved in this study, also emphasized that “adults with high blood pressure, particularly those who consume a lot of sodium and relatively little potassium, are likely to benefit most [from making this switch], provided they have healthy kidney function.”
“People who regularly add salt during cooking or at the table may also see greater benefits from switching, although reducing sodium in packaged and restaurant foods is still important,” Routhenstein highlighted.
How does potassium-enriched salt support kidney and cardiovascular health?
“Potassium-enriched salt replaces some of the sodium chloride in regular salt with potassium chloride, helping reduce sodium intake while increasing potassium, both of which can help lower blood pressure. Better blood pressure control reduces strain on the heart and blood vessels and helps protect the kidneys from long-term damage,” Routhenstein explained.
Still, even this heart-healthy salt option may not be the right choice for everyone.
“People with advanced kidney disease, or those taking medications that affect potassium levels, should consult their doctor” before making the switch, Huang advised.
“Because the kidneys are responsible for removing excess potassium from the body, severely impaired kidney function can lead to potassium accumulating in the blood, which may cause serious heart rhythm problems,” the researcher explained.
“More generally, people with significant kidney impairment are often advised to reduce their intake of all types of salt,” she added.
Routhenstein echoed these caveats, adding that people should also pay particular attention to what medications they’re taking when considering their options.
Caution: Mind interactions with medications
“Certain medications, including lisinopril, losartan, spironolactone and Entresto, can increase blood potassium levels,” Routhenstein pointed out.
“Combining them with potassium-enriched salt substitutes can raise the risk of dangerously high potassium, which can disrupt the heart’s electrical activity and cause potentially life-threatening arrhythmias,” she cautioned.
“People taking these medications, especially those with reduced kidney function, should consult their healthcare provider before making the switch,” the dietitian emphasized.
Routhenstein also told MNT that everyone, regardless of their health status, should keep in mind a few important points when considering the amount and type of salt they include in their diets.
As for the global perspective, Huang told MNT that she and her colleagues are hoping their research may eventually aid the improvement of global health and nutrition policies.
Efficient and cohesive implementation of changes, however, may be a challenge to reckon with.
“Our study helps quantify the potential health benefits of switching to potassium-enriched salt at a population level. We hope these findings encourage policymakers and public health agencies to explore ways of increasing its use. However, implementation will need to be tailored to local contexts, taking into account factors such as dietary habits, affordability, availability, and regulatory considerations. We have a multidisciplinary team of researchers who would be delighted to work with interested partners to turn this evidence into action and help improve population health.”
— Liping (Polly) Huang, PhD
