Swapping salt substitutes could reduce heart and kidney disease globally

Replacing regular table salt with a potassium-fortified alternative could prevent nearly three million deaths and more than 10 million cases of heart and kidney disease worldwide each year, according to a major study published in Nature Health.

Researchers at the George Institute for Global Health, based in Australia, analyzed the dietary habits and disease risks of 4.6 billion adults in 193 countries to estimate the potential benefits of this change.

The study relied on mathematical simulations rather than a clinical trial, using estimates whose precision can vary, the researchers acknowledged.

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High blood pressure affects about 1.4 billion adults worldwide and is a leading cause of strokes, heart attacks and chronic kidney damage, according to the World Health Organization.

Excessive salt consumption can contribute to high blood pressure because its sodium content causes the body to retain water, increasing blood volume and putting additional pressure on artery walls.

Replacing regular table salt with a potassium-fortified alternative could prevent nearly three million deaths and more than 10 million new cases of heart and kidney disease worldwide each year, according to a modeling study. (iStock)

Potassium-enriched salt replaces some of the sodium with potassium while still looking, tasting, and cooking like regular salt. According to researchers, this exchange reduces sodium intake while increasing potassium, which helps relax blood vessels and promotes the elimination of excess sodium from the body.

If households replaced only the salt used in home cooking and at the table, the model predicted 1.85 million fewer deaths and 6.19 million fewer new cases of heart and kidney disease per year.

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In another scenario, replacing salt only in restaurant meals and processed foods is expected to prevent about 1.56 million deaths and 5.46 million new cases of illness per year.

In a more targeted scenario, researchers projected that replacing 80 percent of adults with high blood pressure with potassium-fortified household salt could prevent about 590,000 deaths worldwide each year.

If households replaced only the salt used in home cooking and at the table, the model predicted 1.85 million fewer deaths and 6.19 million fewer new cases of heart and kidney disease per year. (iStock)

Projected benefits varied by region, depending on population size and sources of dietary sodium. The greatest potential benefit was seen in China, with approximately 1.08 million deaths avoided each year through complete replacement.

India follows with nearly 400,000 preventable deaths, while the United States could potentially avoid about 105,000 deaths and 492,000 new cases of disease per year.

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In many Asian and African countries, most dietary salt comes from home cooking, suggesting that greater awareness and access to potassium-fortified alternatives could encourage healthier habits, researchers say.

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Wider adoption by food manufacturers and restaurants would be needed to maximize health benefits in Western countries, where more than 70% of dietary sodium comes from processed foods and restaurants, the study suggests.

“This study shows that small changes have a huge impact on two globally important diseases: cardiovascular disease and kidney disease,” Dr. Nathan Goodyear of the Williams Cancer Institute in California told Fox News Digital.

Although the study’s models suggest that the benefits to heart health outweigh the risks for the general population, experts have cautioned that the substitute may not be safe for everyone. (iStock)

Goodyear, who was not involved in the study, said the most important message to take away is that health is “not something we are born with.”

“It’s something we cultivate. It’s the environment we cultivate,” he said. “And this environment influences disease harvesting potential long before the disease is diagnosed.”

Potential risks

Although the study’s models suggest that the benefits to heart health outweigh the risks for the general population, experts have cautioned that the substitute may not be safe for everyone.

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Potassium-fortified salt substitutes may also pose risks, including hyperkalemia, a condition in which excess potassium builds up in the blood and can trigger dangerous irregular heart rhythms, according to the National Kidney Foundation.

Because excess potassium can trigger dangerous heart rhythms in people whose kidneys can’t filter it properly, people with advanced chronic kidney disease or those taking certain blood pressure medications should consult a doctor before making the change. (iStock)

The body normally eliminates excess potassium through urine, but people with advanced kidney disease or those taking certain blood pressure medications may have difficulty eliminating it.

The World Health Organization does not recommend potassium-fortified salt substitutes for people with kidney problems that impair potassium elimination unless recommended by a healthcare professional.

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“We’re constantly in medicine looking for the silver bullet to solve problems of causation, for the treatment of disease, (but) it doesn’t exist,” Goodyear said.

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Chronic illnesses such as heart disease, kidney disease, diabetes and cancer often develop over time due to multiple contributing factors, the doctor noted.

Widespread adoption could also face challenges, because potassium-fortified salt costs on average about twice as much as regular salt and would require cooperation from food manufacturers and suppliers, the researchers say.