Potassium Enriched Salt Could Prevent Nearly 400,000 Deaths a Year in India, Study Estimates

A change in salt could bring large health gains

Replacing ordinary salt with a mixture containing potassium could prevent an estimated 399,884 deaths and 1,528,494 new cases of cardiovascular and chronic kidney disease in India every year, according to a study covering 193 countries and territories. The projected gains would come from changing salt used both at home and in commercially prepared food.

The research, published in Nature Health on 4 November 2026, estimates that a worldwide switch could prevent 2.96 million deaths and 10.17 million new cases annually. India and China would have the largest absolute benefits, reflecting their large populations, salt consumption and burden of heart and kidney disease.

Researchers including Liping Huang and Bruce Neal examined a substitute containing 75% sodium chloride and 25% potassium chloride. Ordinary salt is sodium chloride. Replacing a quarter of it with potassium chloride reduces sodium while increasing potassium, addressing two dietary factors that contribute to high blood pressure.

The figures are annual projections from a computational model. The researchers calculated how changes in salt consumption could affect blood pressure and, through it, the risk of disease and death. Achieving those gains would require widespread adoption, affordable products and safeguards for people whose bodies have difficulty handling potassium.

How the researchers calculated the benefits

The Nature Health study, titled Global health outcomes from replacing dietary sodium chloride with potassium-enriched salt, compared five approaches: replacing all added salt, replacing household salt, replacing salt in processed and restaurant foods, and two narrower strategies for people with diagnosed or treated hypertension.

Hypertension means persistently high blood pressure. The model first estimated changes in sodium and potassium intake, then translated them into changes in systolic blood pressure, the upper number in a blood pressure reading. It used those changes to estimate subsequent cardiovascular and kidney outcomes.

Worldwide replacement of all added salt produced the largest projected benefit: 2.96 million fewer deaths annually, with a 95% uncertainty interval of 2.81 million to 3.12 million. That interval describes the range generated by uncertainty in the data and assumptions used in the calculation.

The estimated reductions represented 14.6% of annual deaths and 13.1% of new cases from cardiovascular and chronic kidney disease. Researchers also calculated 69.43 million disability-adjusted life years prevented each year. This measure combines years lost through early death with years spent living with illness or disability.

The model deducted potential deaths caused by excessive blood potassium from deaths prevented through lower blood pressure. Its estimates for new disease cases and disability-adjusted life years covered the benefits mediated through blood pressure reduction.

Why sodium and potassium matter together

Average global sodium intake was 4.3 grams a day in the study, compared with the World Health Organization recommendation of less than 2 grams. Average potassium intake was 2.3 grams daily, below the recommended minimum of 3.5 grams.

Sodium and salt are different measurements: sodium is one component of sodium chloride. Two grams of sodium corresponds to about 5 grams of ordinary salt. Keeping the measurements separate helps explain why a daily salt figure can be much larger than a sodium recommendation.

Excess sodium and insufficient potassium contribute to high blood pressure, which increases the risk of strokes, heart attacks and kidney disease. A substitute containing potassium changes both parts of that dietary balance at once.

Bruce Neal, senior professorial fellow at The George Institute for Global Health in Australia, described the benefit of that combined approach:

Switching to potassium-enriched salt addresses both these dietary issues at the same time, with substantial health benefits.

The study found that at least 10% of cardiovascular deaths could be prevented in 133 of the 193 countries and territories under the full replacement scenario. Many of those countries were in Asia, North America and Latin America.

What an Indian trial found in practice

Evidence from rural India gives a more immediate view of what changing salt can do. The Salt Substitute in India Study involved 502 participants with hypertension and compared a substitute containing potassium with ordinary salt over three months.

The George Institute India described the findings in its January 2025 statement. Participants began with average urinary salt excretion of 10.4 grams daily, a measure used to assess salt intake. That was more than twice the WHO recommended daily salt intake.

Participants assigned the substitute had systolic blood pressure reductions of 4.6 millimetres of mercury and diastolic reductions of 1.1 millimetres of mercury compared with those using regular salt. Diastolic pressure is the lower number in a reading and measures pressure between heartbeats.

The trial also recorded improved urinary potassium and a better sodium to potassium ratio. Participants reported regular use and found the taste acceptable. Those findings matter because a dietary change is easier to sustain when people can continue cooking familiar meals.

The sequence of guidance and research shows how the evidence has developed:

• In 2025, WHO endorsed lower sodium salt substitutes containing potassium as an approach to reducing sodium intake.
• On 29 January 2025, The George Institute India welcomed the recommendation and highlighted findings from its study of 502 rural participants.
• On 4 November 2026, the Nature Health study extended the analysis to five replacement strategies across 193 countries and territories.

Household kitchens offer a substantial starting point

Replacing only salt used in home cooking and seasoning could prevent 1.85 million deaths and 6.19 million new cardiovascular and chronic kidney disease cases worldwide each year, the model estimated. This approach delivered about 63% of the projected mortality benefit of replacing salt from all sources.

India, China, Indonesia and Russia together accounted for more than 60% of the global benefit projected from changing household salt. The finding gives governments a concrete reason to consider household access alongside food industry reform.

India's estimated 399,884 preventable deaths equal about 13.5% of the worldwide projection of 2.96 million. China's estimated 1.08 million represent about 36.5%. Together, the two countries account for roughly half of the modelled global reduction in deaths.

The scale of the household opportunity also depends on continued use. In the largest and longest trial discussed by the researchers, 92% of participants assigned a substitute containing 25% potassium chloride were still using it after five years. The researchers reported that most people could make the switch without detecting a change in taste.

Food manufacturers and restaurants also have a role

Replacing salt only in processed and restaurant foods could prevent an estimated 1.56 million deaths and 5.46 million new disease cases globally each year. That amounts to about 53% of the mortality benefit projected under the full replacement strategy.

The household and commercial estimates describe separate scenarios. The combined model accounts for how both changes affect the same population and produces the total of 2.96 million deaths prevented.

More than 70% of dietary salt in Europe and North America comes from processed foods and restaurant meals. People in those settings receive much of their sodium before they reach for a salt shaker, making changes by manufacturers and restaurants central to achieving the projected gains.

The United Kingdom could prevent nearly 13,000 deaths and around 60,000 new cardiovascular and kidney disease cases annually under a complete switch. The United States replaced Russia among the four countries with the greatest projected benefit when researchers focused specifically on commercially prepared food.

Food production brings practical constraints. Manufacturers would need to adjust recipes and production processes, meet regulations and obtain sufficient potassium chloride. The researchers said these factors could limit how much of the projected commercial benefit is achieved.

Kidney disease requires particular precautions

People with advanced kidney disease and those taking medicines that substantially increase blood potassium need medical advice before using these substitutes. Damaged kidneys can struggle to remove excess potassium, allowing it to accumulate in the blood. This condition, called hyperkalaemia, can cause dangerous heart rhythm problems.

Among people with chronic kidney disease stages G3 to G5, the model estimated that full salt replacement could prevent 750,000 cardiovascular deaths annually through lower blood pressure while potentially causing 100,000 deaths from hyperkalaemia. The projected balance was more than seven cardiovascular deaths prevented for every potential death caused.

The researchers nevertheless identified safety as a central implementation issue. Most previous trials asked people at elevated risk of hyperkalaemia to exclude themselves. Evidence about potassium related harm in these groups remains limited, and the model's safety calculations depend on assumptions about that risk.

Vivek Jha, a nephrologist and senior professorial fellow at The George Institute in India, described the precautions needed:

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.

Recommended safeguards include kidney disease screening, standard warning labels, identification of potassium enriched salt in food ingredient lists and potassium information on packaged foods. The George Institute India's January 2025 statement also called for more safety and efficacy evidence in people with kidney disease.

A targeted strategy could begin through clinical care

Replacing household salt only for the estimated 658 million people worldwide with diagnosed hypertension could prevent 590,000 deaths annually. Restricting the change to the 523 million receiving hypertension treatment could prevent 480,000 deaths.

These narrower strategies offer smaller population benefits but connect the change to an existing medical visit. Clinicians could review kidney function and medicines, explain product labels and identify people who should avoid additional potassium.

The model assumed that 20% of adults with diagnosed or treated hypertension would be advised against using the substitute because of possible kidney disease or hyperkalaemia risk. The proportion would vary between countries and patient groups.

Researchers also tested incomplete adoption. Replacing half of all regular salt produced an estimated 1.72 million fewer deaths annually, while replacing one fifth produced 700,000 fewer deaths. Those calculations suggest that substantial gains could begin before a complete transition.

Price, supply and better data will shape adoption

Potassium enriched salt costs about twice as much as regular salt on average, according to the study. Potassium chloride is more expensive than sodium chloride, and substitutes are often sold as specialist health products.

Vivekanand Jha, executive director of The George Institute India, called for affordability, wider availability, clear labelling and subsidies in the institute's January 2025 statement. For Indian households, those measures would determine whether switching salt becomes a routine grocery choice.

A global transition would also require greater potassium chloride production and participation from retailers, food manufacturers, clinicians and governments. The researchers expected full implementation to take decades, drawing a comparison with the long international transition to iodized salt.

The exact benefit for each country remains uncertain. Some underlying data were several years old, and information on the share of salt coming from households rather than commercial food was limited. Additional national data would help governments choose where to begin.

Even when researchers changed assumptions about the blood pressure effects of sodium and potassium, their alternative full replacement calculations projected between 2.02 million and 2.72 million deaths prevented annually. For India, the practical task is to connect that potential with affordable products and clinical safeguards while continuing efforts to reduce salt consumption and treat hypertension.

Key Points

• India could prevent an estimated 399,884 deaths and 1,528,494 new cardiovascular and chronic kidney disease cases annually through full salt replacement.
• The global study modelled a mixture containing 75% sodium chloride and 25% potassium chloride across 193 countries and territories.
• Worldwide replacement could prevent 2.96 million deaths and 10.17 million new disease cases each year.
• A trial involving 502 rural Indian participants with hypertension recorded lower blood pressure after three months of substitute use.
• People with advanced kidney disease or medicines that raise potassium need medical advice before switching.
• Affordability, labelling, supply and participation by food producers will determine how widely the change can be adopted.