Replacing regular table salt with a potassium-enriched alternative could reduce stroke risk by 14 percent and cardiovascular deaths by 12 percent, at a fraction of the cost of drug-based interventions, according to a new report by leading Indian doctors, nutrition researchers, and epidemiologists.
The report calls for government endorsement of low-sodium salt substitutes (LSSS), which replace 15–30 percent of sodium chloride with potassium chloride, for widespread household use.
Prepared by the George Institute for Global Health (GIGH), along with a group of medical experts and researchers, the white paper urges the Food Safety and Standards Authority of India (FSSAI) and the Union government to promote LSSS as a routine alternative to regular salt in Indian homes.
This comes a year after the World Health Organisation recommended replacing regular salt with LSSS for adults without kidney conditions, citing growing evidence that lowering blood pressure is critical to reducing cardiovascular and chronic kidney diseases.
These guidelines apply to the general adult population, excluding pregnant women, children, and individuals with impaired potassium excretion.
An average Indian consumes 8–11 grams of salt daily – well above the 5-gram limit recommended by both WHO and the ICMR–National Institute of Nutrition.
Nearly 27 percent of Indian adults – around 199 million people – have hypertension, while about 25 percent of adolescents aged 13-19 are also affected. Cardiovascular diseases account for 27 percent of all deaths in India, with an estimated 175,000 deaths each year directly linked to high salt intake.
Around 80 percent of sodium consumption in India comes from discretionary salt added during cooking or at the table, pointed out Dr Vivekanand Jha, executive director, GIGH.
This makes household-level interventions crucial to reducing overall sodium intake and achieving the national target of a 30 percent reduction.
HOW IT HELPS
Low-sodium salt substitutes reduce sodium content by replacing sodium chloride with compounds such as potassium, calcium, or magnesium salts. These formulations can lower sodium levels by at least 25 percent while largely preserving taste and texture.
A teaspoon of salt (about 5 grams) contains roughly 2 grams of sodium. Increasing potassium intake helps counteract sodium’s effects, promotes urinary sodium excretion, and supports vasodilation, thereby lowering blood pressure.
The WHO recommends a sodium-to-potassium ratio of 1:1 or lower, with sodium intake capped at 2,000 mg per day and potassium intake at 3,500 mg or more.
However, Indian diets are typically low in potassium-rich foods such as fruits, vegetables, pulses, legumes, and nuts. The average daily potassium intake stands at about 2.25 grams in the country, well below the recommended 3.5 grams.
Evidence from the Salt Substitute and Stroke Study (SSaSS), a large clinical trial in China, showed that using potassium-enriched salt reduced stroke risk by 14 percent, major cardiovascular events by 13 percent, and premature deaths by 12 percent over five years.
A randomised controlled trial in rural India also found a 4.6 mm Hg reduction in systolic blood pressure among participants using LSSS, the report noted.
Modelling studies suggest nationwide adoption could prevent 8–14 percent of cardiovascular deaths annually.
KIDNEY RISK CONTEXT
Concerns about hyperkalemia – a potentially dangerous buildup of potassium in the blood – have limited the widespread adoption of LSSS, particularly among people with chronic kidney disease (CKD) or those taking potassium supplements or potassium-sparing medications.
About 12 percent of Indian adults are estimated to have CKD.
However, emerging evidence indicates that optimal potassium intake is safe for most individuals with the condition.
The 2024 KDIGO guidelines support potassium-rich diets for many CKD patients, recommending restriction only in advanced stages or when hyperkalemia occurs.
POLICY PUSH NEEDED
The report calls for measures to improve the affordability and availability of LSSS in India, including classifying it under the edible salt category and ensuring clear labelling.
Currently, these substitutes are available only in limited regions and can cost up to twice – or even more – as much as regular salt. Researchers also stress the need to ensure that LSSS is iodised, just like regular salt.
Iodine fortification has been a key public health strategy in over 120 countries, including India, where it has helped prevent iodine deficiency disorders such as goitre, brain damage, and developmental delays.
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