Using Potassium Salt Instead of Table Salt Could Save Millions of Lives

• Replacing regular table salt with potassium-fortified salt could avert nearly 105,000 deaths a year in the U.S. and millions more worldwide, according to a new study.
• Potassium-fortified salt swaps part of the sodium chloride in table salt for potassium chloride, which is linked to lower blood pressure, according to The George Institute and the American Heart Association (AHA).
• Salt substitutes are sold at major U.S. grocery stores.

A small change in the salt people use could prevent millions of cardiovascular-related deaths, new research suggests.

Researchers at The George Institute for Global Health modeled what would happen if 193 countries switched from regular table salt to potassium-fortified salt. The findings were published in Nature Health.

The study estimated that the change could prevent nearly 3 million deaths and more than 10 million new cases of heart and kidney disease worldwide each year.

For the United States alone, the researchers projected nearly 105,000 fewer deaths and about 492,000 fewer new cases annually.

About 130.6 million U.S. adults have cardiovascular disease, according to the American Heart Association (AHA).

Estimating the impact of a salt substitute

Liping Huang, PhD, a senior data analyst in the Food Policy Division at The George Institute for Global Health and a co-lead author, said the team began with current blood pressure levels by sex, age, and country.

The researchers then estimated how replacing salt with a substitute would affect sodium and potassium intake, blood pressure, and disease risk.

They modeled a mixture containing 75% sodium chloride and 25% potassium chloride. Based on that scenario, the study estimated these annual global outcomes:

• 2.96 million deaths prevented by switching all salt
• 1.85 million deaths prevented by switching only the salt people use at home
• 590,000 deaths prevented by switching home salt for people diagnosed with high blood pressure

The authors noted that the model used data from several years ago and depended on many assumptions, and that a large-scale switch would likely take years.

What potassium-fortified salt is

Potassium-fortified salt replaces some of the sodium chloride in ordinary table salt with potassium chloride, according to The George Institute.

When asked about other salts such as kosher salt and sea salt, Huang said they may contain trace elements that create a health halo, but they are still mainly sodium chloride.

She added that potassium-fortified salt tastes about the same as regular table salt, though a small number of people with especially sensitive taste buds may notice a difference.

How it may lower blood pressure

Huang said it is very difficult for people to simply reduce 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,” she said.

According to Cheng-Han Chen, MD, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California, the two minerals have opposite effects in the body. Chen was not involved in the study.

“While sodium causes water retention and increased blood pressure, potassium will help the kidneys remove sodium from the body and lower blood pressure,” Chen told Healthline.

Huang said she also worked on an earlier trial involving about 21,000 people in 600 rural villages in northern China.

A 2021 study in The New England Journal of Medicine, which summarized the trial results, found that people who used potassium-fortified salt had a 14% lower risk of stroke, a 13% lower risk of cardiovascular events, and a 12% lower risk of early death compared with those using regular salt.

The World Health Organization endorsed potassium-fortified salt in a recent guideline, saying it can reduce blood pressure and the risk of cardiovascular disease.

The AHA says potassium-based salt substitutes can help lower blood pressure in some adults. The Food and Drug Administration issued labeling guidance allowing an alternate name for potassium chloride on ingredient labels to include the word “salt.”

Chen said blood pressure may begin to improve within about one week of cutting sodium intake, while the full benefit usually takes up to four weeks.

Recommended daily sodium limits

“We generally recommend a daily sodium limit of 2,300 milligrams (mg), ideally under 1,500 mg a day. Most people consume over 3,000 mg of sodium a day, well above the recommended limit,” Chen said.

The WHO recommends less than 2,000 mg of sodium per day and suggests at least 3,510 mg of potassium a day.

In the United States, more than 70% of salt intake comes from processed and restaurant foods, according to the AHA.

Who should avoid potassium-fortified salt

Huang said some people with advanced chronic kidney disease should avoid potassium-fortified salt.

When the kidneys do not function well, the body may not be able to remove extra potassium efficiently. That can lead to hyperkalemia, or high potassium in the blood, which may raise the risk of cardiac arrest.

Among people with stage 3 to stage 5 kidney disease, switching to salt substitutes could prevent about 750,000 deaths a year by lowering blood pressure, but it could also cause about 100,000 deaths a year from hyperkalemia, the researchers estimated.

The AHA says people with kidney disease or those taking medications that affect potassium should check with a healthcare professional before using these products.

An estimated 37 million U.S. adults have chronic kidney disease, according to the Centers for Disease Control and Prevention (CDC).

Where to find potassium-fortified salt

Potassium-fortified salt is available at supermarkets in the U.S. Several major grocery chains, including Kroger, Walmart, and Publix, carry two types of products, according to their websites.

The study says potassium-fortified salt typically costs about twice as much as regular salt.

Huang said she hopes the findings will encourage people to think of the switch as “a simple thing I can do for their own health.”