Swapping common salt for a version with less sodium and more potassium could prevent almost 3 million deaths a year worldwide, according to estimates. This means that around 15 out of every 100 deaths caused by heart, circulation and kidney diseases could be prevented. In this type of salt, a quarter of the composition is potassium chloride, which replaces part of the traditional salt.
The calculation is in a study published in Nature Health by researchers from The George Institute for Global Health, in Australia, with the participation of institutions from the United States and Europe. In the bigger picture, the switch could also prevent more than 10 million new cases of these diseases each year.
The work is mathematical modeling, not an experiment with patients. The authors crossed information on salt consumption, blood pressure and disease burden in 193 countries with data from previous studies on the effect of sodium and potassium on blood pressure, to estimate what would happen if adults started seasoning their food with enriched salt, at home, in industry and in restaurants.
Seasoning that acts on both sides of the pressure
Excess sodium causes the body to retain water, the volume of blood circulating increases and the arteries become more rigid, which pushes the pressure up.
Potassium works in the opposite direction: it helps the kidneys eliminate sodium through urine and promotes the relaxation of vessels.
The world's population consumes, on average, more than twice the recommended sodium and less potassium than they would need, and enriched salt corrects both distortions at once.
For Elzo Mattar, cardiologist, director of the Arterial Hypertension Department of the Brazilian Society of Cardiology (SBC) and professor at the Faculty of Medicine of São José do Rio Preto (Famerp), potassium has its own weight in this story.
In a large clinical trial carried out in China with enriched salt, the increase in potassium measured in urine was much more significant than the drop in sodium, and a subsequent analysis indicated that it accounted for much of the pressure reduction.
High blood pressure, in turn, is the most correctable risk factor for heart attack, stroke and kidney disease, so lowering it protects the heart, brain and kidneys at the same time.
A central point in the researchers' argument is the taste: in the proportion of 75% sodium chloride and 25% potassium chloride, most people do not notice a difference. Reducing salt, on the contrary, requires accepting less salty food, a change in taste that has almost never been successful on a population scale.
The test with 21 thousand people in China
The Chinese trial, published in 2021, followed nearly 21,000 people from 600 rural villages for around five years.
The Nature Health authors cite it as the largest and longest-running product ever, and from it comes the 75% sodium, 25% potassium formula used in the simulation. The participants had a history of stroke or were over 60 years old with high blood pressure, and some of them, chosen by lottery, started cooking with enriched salt.
This group had 14% fewer strokes, 13% fewer serious cardiovascular events and 12% fewer deaths from any cause than the group that stuck to regular salt. After five years, more than 90% were still using the product, and the effect appeared even among volunteers who, for the most part, were already taking medication for their blood pressure.
Those responsible for the study admit that the main number depends on assumptions about how sodium and potassium act on blood pressure, and that there is less evidence about the effect of potassium in those without hypertension.
In the most conservative scenarios, which reduce the effect of potassium or limit the benefit to hypertensive patients, the estimate is between 2 million and 2.7 million deaths avoided per year.
The biggest part of the profit is in the home kitchen
The simulation separated the salt that each person uses for seasoning from the salt that is already included in processed foods and restaurant meals. Changing your home alone could prevent 1.85 million deaths per year, around 63% of the total benefit.
Cardiovascular surgeon Ricardo Kazunori, from BP – A Beneficência Portuguesa de São Paulo, observes that the consumption of processed foods and restaurant meals via delivery is growing in Brazil, but that the domestic salt shaker continues to be the main responsible for the excess, as the measure of 5 grams per day is rarely respected at home.
The benefit is not restricted to those who have already been diagnosed. If only people with confirmed hypertension made the switch, around 590,000 deaths could be avoided per year, approximately a fifth of the total.
Mattar explains that the rest of the population also benefits, because blood pressure rises naturally with age, many people have hypertension without knowing it and most heart attacks and strokes occur among people with only slightly high blood pressure, simply because they are the majority.
The researchers consider that the focus restricted to hypertensive patients would be the simplest to apply in the short term, as it would reach those who are already monitored by doctors.
Excess potassium can pose a risk
The main concern with the change is hyperkalemia, excess potassium in the blood. Kazunori describes the mechanism: "Heart cells depend on the difference in electrical charge between the inside and outside to contract. When potassium rises too much outside them, this difference decreases and the rhythm can become disorganized, leading to cardiac arrest."
The risk falls mainly on those with moderate or advanced kidney disease, because diseased kidneys eliminate potassium poorly, and on those who use supplements or certain medications that make the body retain the substance, such as potassium-sparing diuretics and some blood pressure medications, common in those with heart failure or diabetes with compromised kidneys.
In these cases, the two experts recommend talking to your doctor before adopting enriched salt, so that he can evaluate kidney function and, if necessary, order creatinine and potassium blood tests.
In the model, the researchers calculated the toll for the 239 million adults in the world with moderate to advanced kidney disease: enriched salt could cause around 100,000 deaths from hyperkalemia, but would prevent 750,000 cardiovascular deaths, more than seven for each one caused by excess potassium.
The account assumes that all these people would use the product without any filter, and the authors estimate that the projected harm is therefore greatly overestimated. In clinical studies, in which people with severe kidney disease are often left out, there was no increase in clinical complications from excess potassium.
What changes for Brazilians
Brazilians consume around 9 grams of salt per day, almost double the 5 grams, a level teaspoon, that the World Health Organization (WHO) recommends as a daily limit. According to Kazunori, 25% to 30% of adults in the country have hypertension, and cardiovascular diseases are the leading causes of death.
In 2025, the WHO published a guideline recommending salt substitutes with potassium, and European and North American guidelines for hypertension followed suit.
The light salt sold in supermarkets is not identical to the one in the study, according to Kazunori. The product on the shelves usually has about half potassium, a higher proportion than the 25% tested, which reduces sodium more, but also increases potassium more and reinforces the need for medical advice for those with kidney problems.
The price also matters: for Kazunori, a public prevention policy would require tax incentives, information campaigns and encouragement for the industry to reduce sodium in ultra-processed foods.
None of these changes authorize exaggeration in the salt shaker.
“Enriched salt still contains three quarters of sodium, and the goal remains to eat less salt in total, adding up everything that goes on the plate,” says Mattar.
Much of the sodium comes from sausages, cubed broths, ready-made and ultra-processed sauces, while fruits, vegetables, legumes and beans are natural sources of potassium.
The study authors emphasize that none of the scenarios represents an immediate gain. Switching salt around the world tends to take decades, and the precedent is that of iodized salt, whose adoption on a global scale has dragged on for almost a century. The price, which today is equivalent to on average twice that of common salt, the supply on the shelves and the support of the food industry will determine whether the projection comes to fruition.
