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In a renewed effort to reduce global sodium intake, the World Health Organization (WHO) has recommended that people consider replacing regular table salt with lower-sodium salt substitutes (LSSS). This recommendation comes as part of WHO’s ongoing mission to curb hypertension and cardiovascular diseases (CVDs), which are among the leading causes of death worldwide.
Background: The Global Sodium Intake Challenge
In 2012, WHO issued guidance advising individuals to limit their sodium intake to below 2 grams per day (g/day) to reduce blood pressure and the risk of CVDs. Member States collectively set a target to reduce mean population sodium intake by 30% by 2030 as part of a broader strategy to prevent and control non-communicable diseases (NCDs). However, progress has been slow. By 2019, global sodium intake remained high, averaging 4.3 g/day—more than double WHO’s recommendation. This alarming statistic highlights the urgency for accelerated interventions to achieve sodium reduction targets.
The Role of Lower-Sodium Salt Substitutes (LSSS)
Sodium chloride (NaCl), commonly known as table salt, is the primary source of dietary sodium, added both by consumers and the food industry. LSSS are alternatives to regular salt that contain less sodium and often include potassium chloride (KCl) to maintain a similar flavor profile. These substitutes can be used in home cooking, restaurant meals, processed foods, and sodium-containing condiments like soy sauce and fish sauce.
In addition to reducing sodium intake, LSSS offer the added benefit of increasing potassium intake, which WHO has recommended as a means of lowering blood pressure and reducing CVD risk. However, WHO specifies that potassium intake should come from food sources rather than supplements or salt substitutes alone. Despite their advantages, the global use of LSSS lacks standardized guidance, and concerns persist regarding the safety of potassium-enriched salts for individuals with impaired kidney function.
Scientific Evidence Supporting LSSS
A systematic review of 26 randomized controlled trials (RCTs) conducted between 1986 and 2021, involving 34,961 adults and 92 children, evaluated the health impacts of LSSS. The findings demonstrated significant reductions in blood pressure among adults who replaced regular salt with LSSS over follow-up periods ranging from 56 days to five years.
Additionally, LSSS use was associated with a reduced risk of major cardiovascular events such as strokes, and heart attacks.
Despite concerns about hyperkalaemia (elevated blood potassium levels), the review found that LSSS had minimal effects on potassium levels in the general population, except in individuals with pre-existing kidney impairments.
WHO’s Recommendations on LSSS
To mitigate hypertension and reduce CVD risks, WHO strongly recommends lowering sodium intake to below 2 g/day. As part of this broader sodium reduction strategy, WHO suggests replacing regular table salt with LSSS containing potassium. However, this recommendation applies only to adults and excludes pregnant women, children, and individuals with conditions that may hinder potassium excretion, such as kidney disease.
The guideline was developed following WHO’s rigorous evidence-based review process, including an assessment of systematic data using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.
Manbilas Singh is a talented writer and journalist who focuses on the finer details in every story and values integrity above everything. A self-proclaimed sleuth, he strives to expose the fine print behind seemingly mundane activities and aims to uncover the truth that is hidden from the general public. In his time away from work, he is a music aficionado and a nerd who revels in video & board games, books and Formula 1.
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