Replacing ordinary salt with a potassium-enriched substitute could prevent about 3 million deaths worldwide every year, including about 400,000 in India, according to a modelling study by the George Institute for Global Health published in Nature Health. The estimate rests on strong trial evidence that such salt lowers blood pressure and strokes. But it depends on assumptions about uptake, and it requires care for people with advanced kidney disease.
Few public-health measures are as cheap or as easy to adopt as changing the salt people already use. A study published on 4 November in Nature Health estimates how many lives that could save.
Researchers led by the George Institute for Global Health modelled what would happen if adults in 193 countries switched from ordinary salt, which is sodium chloride, to a blend of 75% sodium chloride and 25% potassium chloride. They estimated the effect on blood pressure from each country’s data by age and sex, then calculated the resulting cardiovascular disease (CVD) and chronic kidney disease (CKD) events and deaths. The study covers about 4.6 billion adults.
The headline numbers
If all salt were replaced, at home and in processed and restaurant food, the model projects about 2.96 million deaths and 10.17 million cases of cardiovascular and kidney disease prevented each year. More limited scenarios still produce large effects:
| Scenario | Deaths prevented per year | CVD + CKD cases prevented per year |
| All salt replaced | 2.96 million | 10.17 million |
| Home cooking and table salt only | 1.85 million | 6.19 million |
| Processed and restaurant food only | 1.56 million | 5.46 million |
| Only people diagnosed with hypertension | 0.59 million | 1.72 million |
For India, the full-replacement scenario implies about 399,900 deaths and 1.53 million cases of cardiovascular and kidney disease prevented each year. Only China, at about 1.08 million deaths, gains more.
Why potassium helps
Too much sodium raises blood pressure, the leading modifiable risk factor for stroke and heart disease. Too little potassium makes the problem worse; potassium helps the kidneys excrete sodium and relaxes blood vessels. Most diets in India and elsewhere are high in sodium and low in potassium, which comes mainly from fruit, vegetables and pulses. A potassium-enriched salt corrects both at once. As Professor Bruce Neal of the George Institute put it, it “addresses both these dietary issues at the same time”.
The evidence beneath the model
The study is a projection, not a trial, but it builds on one of the largest nutrition trials ever conducted. The Salt Substitute and Stroke Study (SSaSS), published in the New England Journal of Medicine in 2021, enrolled 20,995 people in 600 villages in rural China who had had a stroke or were older with high blood pressure. Over nearly five years, those given a salt substitute had:
- 14% fewer strokes
- 13% fewer major cardiovascular events
- 12% fewer deaths
There was no significant increase in serious hyperkalaemia, a dangerous rise in blood potassium.
In January 2025 the World Health Organization issued a conditional recommendation that adults use lower-sodium salt substitutes, while still aiming to keep salt intake below 5 g a day. It excluded pregnant women, children and people with kidney impairment.
What it means for India
Indians eat considerably more salt than the WHO recommends. A nationally representative study by ICMR’s National Centre for Disease Informatics and Research, published in Scientific Reports in 2023, measured mean intake at 8.0 g a day: 8.9 g for men and 7.1 g for women. ICMR’s National Institute of Epidemiology has cited higher estimates of about 11 g. In 2025 it launched “Project Namak”, a salt-reduction programme in Punjab and Telangana, so the study’s findings are directly relevant to a programme already running in Telangana.
Indian food also changes how a switch would work. In Europe and North America, more than 70% of salt comes from processed and restaurant food, so industry must reformulate. In India, much salt is still added at home: in cooking, in pickles and papads, and at the table. That makes a household switch, the scenario that prevents 1.85 million deaths a year worldwide, more achievable. Indian supermarkets already sell potassium-enriched “low-sodium” salts.
India also has long experience of using salt to deliver public health. Universal iodisation of edible salt, built up over decades from the national goitre-control programme begun in 1962, sharply reduced iodine deficiency. Hyderabad’s ICMR-National Institute of Nutrition developed double-fortified salt, which adds iron to iodised salt to tackle anaemia, and it has been distributed through public food schemes in several states. Those precedents show that the production, regulation and distribution systems for a change in salt already exist. Applying them to potassium would require new standards for composition and labelling, and a price that poorer households can afford.
The caveats
The researchers and independent experts note several limitations.
- Kidney disease. People with advanced chronic kidney disease, or those taking drugs that raise potassium, such as some blood-pressure medicines, can develop dangerous hyperkalaemia. The model estimates that among people with stage 3–5 CKD, lower blood pressure would prevent about 750,000 deaths, against about 100,000 caused by excess potassium. The balance is favourable, but those patients need medical advice. Professor Vivek Jha of the George Institute India said the risk can be managed through “patient education, product labelling, and clinical oversight”.
- Cost and taste. Potassium-enriched salt costs about twice as much as ordinary salt, and some people notice a slightly bitter taste.
- Supply. Global potassium chloride production for food would have to grow substantially.
- Assumptions. The model’s input data are several years old, and the full-replacement scenario is aspirational. Real-world uptake would be partial.
