Salt swap could prevent nearly 3 million deaths a year, model estimates

Replacing ordinary table salt with a version that swaps some of the sodium for potassium could prevent almost three million deaths around the world every year, according to a modeling study published on November 4, 2026, in the journal Nature Health.¹ The researchers, from The George Institute for Global Health, looked at 193 countries. They estimated that a full switch could also prevent about ten million new cases of heart, blood vessel and kidney disease each year.¹

The study did not test the salt on anyone. It is a set of projections built from existing data. That makes it a guide to the possible size of the effect, not a measurement of it.

What the study looked at

Potassium-enriched salt is made by replacing part of the sodium chloride in regular salt with potassium chloride. The researchers say it looks, tastes and cooks like regular salt.¹ Euronews reported that it can be found in some stores and online.²

The team ran several “what if” scenarios for the world’s 4.6 billion adults. These ranged from switching all salt everywhere to switching only the salt used at home by people who already know they have high blood pressure.¹ The estimates for each scenario were:

• Only salt used at home: 1.85 million deaths and 6.19 million heart, blood vessel and kidney disease cases prevented per year.¹
• Only salt in processed and restaurant food: 1.56 million deaths and 5.46 million cases prevented.¹
• Both together: 2.96 million deaths and 10.17 million cases prevented.¹
• Home salt for 80% of people diagnosed with high blood pressure: 0.59 million deaths and 1.72 million cases prevented.¹
• Home salt for 80% of people being treated for high blood pressure: 0.48 million deaths and 1.41 million cases prevented.¹

The first two numbers do not add up to the third, so they should not be read as separate savings that stack on top of each other.

Bruce Neal, a senior professorial fellow at the institute, said a switch could avert as many as one in ten deaths from heart and blood vessel disease in most countries.¹

Where the biggest numbers fall

Because the model counts people, countries with large populations and high rates of heart disease show the largest totals. For a complete switch, the researchers estimated yearly deaths prevented at about 1.08 million in China, 400,000 in India, 105,000 in the United States, 30,000 in Mexico, 18,000 in Nigeria, 13,000 in the United Kingdom, 6,800 in South Africa and 2,100 in Australia.¹ For the UK, that came with around 60,000 heart, blood vessel and kidney disease cases prevented each year.²

The backdrop is large. The World Health Organization (WHO) says about one in three adults aged 30 to 79 has high blood pressure, around 1.4 billion people.² Heart and blood vessel disease caused 19.2 million deaths in 2023 and remains the world’s leading cause of death and disability.²

The evidence the model builds on

The idea rests on blood pressure. Neal said that eating too much sodium and too little potassium are both well-established causes of high blood pressure, and that the substitute addresses both at once.²

Earlier research measured this directly. A 2020 review in the journal Hypertension, by researchers at Johns Hopkins, pooled trial evidence and found that replacing regular salt with potassium-enriched substitutes lowered the top blood pressure number by about 5.6 points and the bottom number by about 2.9 points on average.³

The largest test in people so far was the Salt Substitute and Stroke Study, run by the same George Institute group and published in 2021 in the New England Journal of Medicine.⁴ Almost 30,000 people in 600 villages in rural China took part for five years. All had a history of stroke, or were aged 60 or older with high blood pressure. Half the villages were randomly chosen to get the salt substitute.⁴ Compared with regular salt users, the substitute group had a 14% lower risk of stroke, 13% fewer major heart and blood vessel events and 12% fewer early deaths, with no adverse effects from the higher potassium reported.⁴

In 2025, according to the researchers, the WHO endorsed potassium-enriched salt as a way to lower blood pressure and the risk of heart disease.¹

What it does not show yet

A model is only as good as the data and assumptions fed into it. The sources available do not describe in detail how the model handles differences between countries in diet, health care or how much salt people eat. The main trial behind this type of estimate was done in older, high-risk adults in rural China.⁴ Whether the same size of benefit carries over to younger, healthier people, or to places where most salt comes from packaged food, is an assumption the model makes rather than something it measured.

The full global switch is also hypothetical. Neal called it “aspirational” and described the study as “a starting point to get countries thinking about the opportunity”.¹

Safety is the other open question. The main concern is hyperkalaemia, too much potassium in the blood, in people with advanced kidney disease.¹ The researchers say their model found the benefits outweighed the risks even in that group.¹ But the 2020 Johns Hopkins review said there was not enough evidence on how often the substitutes cause high potassium levels. It noted the dangers can include heart rhythm problems and sudden cardiac death, especially in people whose kidneys struggle to clear potassium.³ That review also called for “robust estimation of the population-wide impact” of a switch, which is what the new study attempts.³

Vivek Jha, a kidney specialist and senior professorial fellow at The George Institute in India, said people with serious kidney disease and those on medicines that strongly raise blood potassium need to take precautions.

Risks for this group can be managed effectively through patient education, product labelling, and clinical oversight.

Jha said this in the institute’s announcement.¹

Who is behind it

The modeling study was led by The George Institute for Global Health in Australia.² The same institute ran the 2021 Chinese village trial, and Neal was the lead author of that paper.⁴ This means the group producing the new global estimate also produced much of the key evidence feeding into it. That is common in research, but it means the model is not an independent check on the earlier trial. The sources read for this article do not say who funded the new study.

Campaign groups have long pushed for this change. After the 2021 trial, the authors called on salt makers to produce substitutes at scale and on governments to promote them.⁴ World Action on Salt, Sugar & Health, an advocacy group, welcomed that trial and cited a UK government advisory review concluding that any potential risk from potassium-based salt is outweighed by the population benefit.⁴

What to watch next

Neal said strategies need to fit each country, depending on whether most sodium comes from salt added at home or from processed food.¹ In Europe and North America, more than 70% of salt intake comes from processed and restaurant foods, so he said the food industry there would need to “get on board”.¹ He also said production of potassium chloride would have to be scaled up to meet demand.¹

Things to follow:

• whether food companies reformulate products with potassium-enriched salt;
• whether governments act on the 2025 WHO guidance with labeling or salt policies;
• new studies on blood potassium levels in people with kidney disease who use the substitutes, the gap the 2020 review flagged;³
• independent groups testing or challenging the model’s assumptions.

Neal argued the approach has “much greater potential and at a much lower cost than many drug-based treatments”.¹ That is a claim about promise. What has been measured so far is a blood pressure drop in pooled trials and fewer strokes and deaths in one large trial of older, high-risk adults in China. The three million figure is what a model projects when those results are applied to the world.