Public health has a long, embarrassed history of recommending interventions that are technically correct and practically ignored. Eat less salt is one of them. The World Health Organization has spent more than a decade urging the world's 194 member states to cut sodium intake by 30% by 2025. Not a single country is projected to hit that target. The reason is not mysterious: people like the taste of salt, the food industry has built entire product lines around it, and asking consumers to settle for "less salty" has, in the blunt assessment of the new Nature Health paper, "proved largely insurmountable."

A study published this week in Nature Health argues there is a way around the taste problem, and that the upside is enormous. The intervention is not a new drug, a device, or a behavioural nudge. It is, essentially, a different kind of salt.

The study at a glance

The paper — "Global health outcomes from replacing dietary sodium chloride with potassium-enriched salt" by Liping Huang, Xiaoyue Xu, Kunihiro Matsushita, Bruce Neal, Matti Marklund and colleagues at The George Institute for Global Health and Johns Hopkins Bloomberg School of Public Health — is the first to model the global impact of a population-wide switch to potassium-enriched salt across all 193 countries for which the Global Burden of Disease Study has data.

The authors used a comparative risk assessment framework. They started with country-level data on sodium and potassium intake, the proportion of sodium that comes from discretionary sources (home cooking and seasoning) versus non-discretionary sources (processed foods and restaurant meals), the prevalence of hypertension and chronic kidney disease (CKD), and the dose-response relationships linking sodium and potassium to systolic blood pressure. They then modelled five scenarios, from the most aggressive (replace all salt, everywhere) to the most targeted (replace discretionary salt only in people already being treated for hypertension), and ran 1,000 Monte Carlo simulations to estimate uncertainty.

The composition they assumed — 75% sodium chloride and 25% potassium chloride — is the same ratio used in the largest randomised trial to date, the Salt Substitute and Stroke Study (SSaSS), published in the New England Journal of Medicine in 2021. SSaSS followed roughly 21,000 rural Chinese villagers for nearly five years and found that those given the potassium-enriched salt had a 14% lower risk of stroke, a 13% lower risk of major cardiovascular events, and a 12% lower risk of premature death compared with those using regular salt. Crucially, 92% of participants in the intervention arm were still using the substitute at the end of year five — an adherence rate that almost no dietary intervention achieves.

The headline numbers

If every country switched all added salt — both at home and in commercial food production — to a 75/25 potassium-enriched blend, the model projects the following annual effects worldwide:

• 2.96 million deaths averted (95% uncertainty interval: 2.81–3.12 million), equivalent to about 14.6% of all annual deaths from cardiovascular disease and chronic kidney disease combined.
• 10.17 million new cases of cardiovascular and kidney disease prevented (9.59–10.70 million), about 13.1% of the annual global incidence.
• 69.4 million disability-adjusted life years (DALYs) saved (65.6–72.9 million), about 16.5% of the global CVD/CKD burden.

For context, cardiovascular disease alone killed roughly 19.2 million people in 2023, and high blood pressure — the single largest modifiable risk factor — drives more than 10 million of those deaths. Anything that takes a 14% bite out of that ledger is, in public-health terms, a once-in-a-generation intervention.

Where the lives would be saved

The geography of the benefit is uneven. Because the model weights by population size, salt intake, and the underlying burden of cardiovascular disease, the largest absolute gains land in the countries with the biggest, saltiest populations. Annual deaths averted under the full-replacement scenario, by selected country:

• China — 1,082,666
• India — 399,884
• USA — 104,787
• Mexico — 30,464
• Nigeria — 18,069
• United Kingdom — 12,951
• South Africa — 6,761
• Australia — 2,076

In 133 of the 193 countries modelled (69%), the intervention would prevent at least 10% of cardiovascular deaths. China, India, Indonesia, and Russia alone account for over 60% of the global benefit when the strategy is restricted to home-cooking salt. The pattern shifts when the model targets only processed-food salt: the United States displaces Russia in the top four, reflecting the fact that more than 70% of dietary sodium in the U.S. and much of Europe now comes from packaged foods and restaurants rather than the salt shaker.

Why the strategy is more than "less salt"

The cleverness of potassium-enriched salt is that it solves two problems at once, in opposite directions. Modern diets deliver too much sodium (global average: 4.3 g/day against the WHO target of 2.0 g) and too little potassium (global average: 2.3 g/day against the WHO target of at least 3.5 g). Both errors raise blood pressure, and both are corrected by the same product swap, with no perceptible change in taste for most consumers.

The mechanism is well understood. Sodium raises blood pressure by expanding blood volume and stiffening arterial walls; potassium does the reverse, promoting sodium excretion in the kidney, relaxing vascular smooth muscle, and blunting the pressor effect of dietary sodium. A meta-analysis of salt-substitution trials has confirmed that the effect on blood pressure is roughly additive: lower sodium plus higher potassium beats either intervention alone. A secondary analysis of SSaSS attributed a meaningful fraction of the cardiovascular benefit specifically to the potassium side of the swap, not just to sodium reduction.

That is why potassium-enriched salt is not the same as "low-sodium salt" or a salt restriction regime. It is a stealth intervention: the diner still salts their fries, the baker still salts their bread, and the food manufacturer still uses the same volume of ingredient in their recipe. The chemistry underneath simply tilts toward potassium instead of sodium.

The kidney-disease question — answered with data, not anxiety

The most serious objection to a population-wide potassium swap is hyperkalaemia: dangerous elevations of blood potassium that can cause fatal arrhythmias, particularly in people whose kidneys can no longer excrete potassium efficiently. Patients with advanced CKD (stages G3–G5) are the population of concern. Most prior trials asked participants to self-exclude if they had known kidney disease, which left the real-world risk profile uncertain.

The Nature Health paper tackles this head-on. Modelling the 239 million adults worldwide with stage G3–G5 CKD, the authors estimate that fully replacing all salt would prevent 0.75 million CVD deaths per year in this exact population through blood-pressure reduction — and might, in the worst-case scenario, cause 0.10 million deaths per year from hyperkalaemia. That is a benefit-to-harm ratio of roughly 7.5 to 1, even before any clinical triage is applied.

In practice, the authors note, the harm is likely overestimated. People with advanced CKD are more often symptomatic, more often diagnosed, and routinely advised by clinicians to limit potassium. The model assumed zero capacity to keep them away from potassium-enriched salt; real implementation would include warning labels, ingredient disclosure on packaged foods, potassium content on nutrition panels, and clinician screening for the patients who need to opt out. If that triage is even modestly effective, the 7.5-to-1 ratio widens further.

For populations or health systems that remain nervous, the paper offers a conservative fallback: target potassium-enriched salt only at people with diagnosed or treated hypertension. That narrower strategy would prevent 0.48–0.59 million deaths per year — about a fifth of the maximum — while largely sidestepping the kidney-disease risk, because those patients are already under clinical care.

The implementation problem, and why it is solvable

A 2.96-million-death outcome is, of course, a modelling exercise, not a guarantee. The authors are candid about the friction between model and reality. Three constraints stand out.

First, price. Potassium-enriched salt currently costs roughly twice as much as regular salt. Some of that premium reflects the fact that potassium chloride is more expensive to mine than sodium chloride, but most of it reflects the product's positioning as a niche health food rather than a commodity. At scale, potassium chloride production rides the same economics as potash mining — unit costs fall as volume rises. Closing the price gap is a question of demand, not of physics.

Second, the food industry. In high-income countries, where more than 70% of dietary sodium arrives via packaged and restaurant foods, no household-level strategy can deliver the full benefit. The food industry has to switch too. The UK Committee on Toxicity has already concluded that replacing 25–30% of salt with potassium chloride in most food categories is feasible and safe, which is the regulatory green light; what is missing is commercial will. Mandated reformulation — modelled successfully by the UK's salt reduction programme in the 2000s — is the obvious lever.

Third, supply. Global potassium chloride production would need to scale substantially to support a worldwide switch. This is not a small task, but it is not unprecedented: the world executed a similar supply-chain transformation when it converted from plain salt to iodized salt over the course of the 20th century, a campaign that prevented tens of millions of cases of cretinism and intellectual disability. The iodization precedent is, in fact, the most encouraging single data point in this entire literature.

The WHO endorsed potassium-enriched salt in its 2025 guideline on lower-sodium salt substitutes. The European and American hypertension guidelines were updated in 2025 and 2026 to reference it. The policy scaffolding is being built.

What about magnesium? Should we add it to the salt?

The reader's question — "should we also add magnesium in there?" — is sharper than it looks. Magnesium is the third mineral in the triumvirate that governs blood pressure, and the evidence for its role is genuinely strong, though less mature than the case for potassium.

The mechanism is plausible and well described. Magnesium is a natural calcium-channel antagonist: it inhibits calcium influx into vascular smooth-muscle cells, which relaxes arterioles and lowers peripheral resistance. It also modulates sodium-potassium ATPase activity and supports endothelial nitric oxide synthesis. A 2011 review by Mark Houston in the Journal of Clinical Hypertension concluded that 500–1,000 mg/day of magnesium can lower blood pressure by as much as 5.6/2.8 mmHg, with the larger effects seen in people who were magnesium-deficient to begin with. A 2025 meta-analysis of 38 randomised trials (roughly 2,700 participants) found a more modest but still significant reduction of about 2.8 mmHg systolic and 1.8 mmHg diastolic, with the largest effects among hypertensive and hypomagnesaemic individuals.

The catch is that magnesium's population-attributable effect is smaller than potassium's for two reasons. First, magnesium deficiency is less prevalent than potassium deficiency in most populations, because magnesium is widely distributed in nuts, seeds, legumes, leafy greens, and whole grains. Second, the dose-response curve for magnesium on blood pressure is shallower than for potassium, and the trial evidence base is thinner — particularly for hard cardiovascular endpoints. There is no magnesium equivalent of SSaSS: no large, multi-year randomised trial has shown that swapping in magnesium-enriched salt reduces strokes or heart attacks.

That said, the combination is genuinely synergistic. Houston's review and subsequent work show that high-potassium, high-magnesium, low-sodium diets (think DASH) produce additive blood-pressure reductions that exceed what any single mineral achieves alone. The DASH diet, which is essentially built around this triad, lowers systolic blood pressure by 8–14 mmHg in hypertensive adults — comparable to a single antihypertensive drug.

So a defensible answer to the reader's question is: magnesium almost certainly belongs in the broader dietary strategy, but probably does not belong in the salt shaker itself, at least not yet. Three reasons. (1) The evidence base for potassium-enriched salt is now mature enough to support policy; the magnesium-enriched-salt evidence base is not. (2) Magnesium chloride has a bitter taste profile that, unlike potassium chloride, is not easily masked at the 10–25% replacement levels used in salt substitutes. (3) The fastest path to the 2.96-million-death outcome modelled in Nature Health is a single, clean, well-studied swap — not a complex reformulation that invites industry resistance and regulatory delay.

The right way to add magnesium is the way the evidence has always suggested: eat the foods that already contain it. A handful of pumpkin seeds, a cup of cooked spinach, a bowl of black beans, an ounce of almonds, or a square of dark chocolate delivers 100–300 mg of magnesium with no reformulation required. For people who do that and switch to potassium-enriched salt, the combined blood-pressure benefit should be at least additive and possibly synergistic.

One caveat worth flagging: magnesium supplementation, like potassium, requires caution in patients with advanced kidney disease, who can develop hypermagnesaemia. Anyone with stage G3–G5 CKD should discuss any mineral supplementation — including the salt swap itself — with their nephrologist before proceeding.

The bigger picture: a "best buy" hiding in plain sight

The WHO classifies a small number of interventions as "best buys" for non-communicable disease: cheap, high-impact, scalable. Potassium-enriched salt now meets every one of those criteria. It is cheap (potentially cheaper than a statin per averted DALY once scaled). It is high-impact (14.6% of CVD/CKD mortality). It is scalable (the iodized-salt precedent shows that a global salt-supply transformation is feasible within a generation). And it sidesteps the single biggest behavioural barrier in dietary public health — the demand that food taste less salty.

The barriers that remain are not scientific. They are industrial (potassium chloride supply, food-industry reformulation), regulatory (mandatory disclosure, reformulation targets), and commercial (price). Every one of those is a policy choice, not a research gap.

Bottom line: what you can do today

If you want to act on this evidence in the next 24 hours, here is the practical order of operations:

1. Check your kidney function. If you have stage 3–5 chronic kidney disease, or you take a potassium-sparing diuretic, an ACE inhibitor, an ARB, or an ARNI, talk to your doctor before switching. Hyperkalaemia is rare but real in this group.
2. Buy a 75/25 potassium-enriched salt for your kitchen. Brands vary by country; look for "low-sodium salt," "salt substitute," or "potassium-enriched salt" with potassium chloride listed as roughly a quarter of the ingredients. If the product is double the price of regular salt, that is still one of the cheapest health interventions in existence.
3. Use it everywhere you would have used regular salt — cooking, seasoning, baking. The taste, for most people, is indistinguishable. If you notice a slight metallic edge, it usually disappears within a week of consistent use.
4. Don't stop there. Most dietary sodium in the U.S., UK, and Western Europe now comes from packaged and restaurant foods, not the salt shaker. Read labels, choose lower-sodium packaged foods, and ask restaurants to lighten the salt. The same logic that justifies the household swap justifies demanding that the food industry make the same swap at scale.
5. Add magnesium through food, not through the salt. A daily serving of leafy greens, legumes, nuts, or whole grains roughly doubles the blood-pressure benefit you get from the salt swap alone, with no reformulation required.
6. Tell your clinician. The 2025 WHO guideline and the 2025–2026 European and American hypertension guidelines now reference potassium-enriched salt. Many primary-care doctors are not yet aware of this. A patient asking is sometimes the fastest way to update a guideline locally.

The full peer-reviewed study, with country-by-country estimates, scenario modelling, and the complete kidney-disease safety analysis, is open-access: Huang L, Xu X, Matsushita K, et al. "Global health outcomes from replacing dietary sodium chloride with potassium-enriched salt." Nature Health (2026). DOI: 10.1038/s44360-026-00216-9.

Sources and further reading

• Huang L, Xu X, Matsushita K, et al. "Global health outcomes from replacing dietary sodium chloride with potassium-enriched salt." Nature Health, 2026. nature.com/articles/s44360-026-00216-9
• The George Institute for Global Health. "A healthier form of salt could prevent millions of deaths from stroke and heart disease." Press release, November 2026. georgeinstitute.org
• Neal B, Wu Y, Feng X, et al. "Effect of Salt Substitution on Cardiovascular Events and Death." New England Journal of Medicine, 2021 (SSaSS trial). nejm.org/doi/full/10.1056/NEJMoa2105675
• Tsai Y-C, et al. "Effectiveness of salt substitute on cardiovascular outcomes." PubMed, 2022. pubmed.ncbi.nlm.nih.gov/36196475
• Greer RC, et al. "Potassium-Enriched Salt Substitutes as a Means to Lower Blood Pressure." Advances in Nutrition, 2020.
• Houston M. "The Role of Magnesium in Hypertension and Cardiovascular Disease." Journal of Clinical Hypertension, 2011. pmc.ncbi.nlm.nih.gov/articles/PMC8108907
• Argeros Z, et al. "Magnesium Supplementation and Blood Pressure: A Meta-Analysis." Hypertension (AHA), 2025. ahajournals.org/doi/10.1161/HYPERTENSIONAHA.125.25129
• World Health Organization. "WHO guideline on use of lower-sodium salt substitutes (LSSS)." Geneva: WHO, 2025.
• NephJC summary of the SSaSS trial. nephjc.com/news/salt-substitute