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Action on Salt

New landmark study finds potassium-based salt substitute significantly reduces risk of stroke and death compared to regular salt




Salt substitutes, where part of the sodium in regular salt is replaced with potassium, have been shown to lower blood pressure. However, until now there has not been a large, high-quality trial investigating the effects of salt substitutes on stroke and death.  

The Salt Substitute and Stroke Study (SSaSS) from researchers at the George Institute for Global Health, was published 29th August 2021 in the New England Journal of Medicine 

Read the paper: Neal B, Wu Y, Feng R et al. Effect of Salt Substitution on Cardiovascular Events and Death. DOI: 10.1056/NEJMoa2105675  

The study investigated the effect of replacing regular salt with a potassium-based salt substitute on the number of cases of stroke, cardiovascular events and death. It also investigated whether there were adverse effects associated with increased potassium intake. 

Almost 30,000 people from 600 villages in rural China took part in the 5-year trial. All participants had a history of stroke or were aged 60+ years and had high blood pressure. Half of the villages were randomly assigned to receive the salt substitute and the other half continued to use regular salt.  

After 5 years, amongst individuals using the salt substitute, researchers found: 

  • 14% lower risk of stroke 
  • 13% fewer major adverse cardiovascular events  
  • 12% fewer premature deaths 
  • No adverse effects of higher potassium intake  

These findings have huge implications for public health. If adopted globally, replacing regular salt with salt substitutes would be a practical and low-cost strategy for preventing millions of premature deaths. As such, the authors are calling for the following actions: 

  • Salt manufacturers and retailers worldwide should switch to producing and marketing salt substitute at scale. 
  • Governments worldwide should design polices to promote salt substitute and discourage regular salt use. 
  • Consumers worldwide should cook, season and preserve foods with salt substitute in place of regular salt. 

View the media coverage here

Professor Feng He, Professor of Global Health Research at the Wolfson Institute of Population Health, Queen Mary University of London, says: 

"This study provides the evidence that using a salt which contains less sodium and more potassium will effectively reduce salt intake and increase potassium, thereby reducing the risk of people suffering from strokes and death from any cause. Globally, millions of lives would be saved by this simple approach. Salt consumption in China is amongst the highest in the world, with average salt intakes (10-12g/day) more than double the WHO recommended limit (less than 5g/day). In China and most developing countries, the majority of salt in the diet is added by the consumer, therefore encouraging people to use less during cooking is the best strategy to improve public health." 

Professor Graham MacGregor, Chairman of World Action on Salt and Health, Professor of Cardiovascular Medicine at Barts and the London School of Medicine said: 

“This very important study clearly demonstrates that for the UK and other developed countries: 

  • Consumers should be encouraged not to add salt to food, but if they have to, it’s vital that they use a reduced sodium with added potassium salt. 
  • The food industry can reduce the huge amounts of salt they add to food, and safely replace it where necessary with potassium salt. 

In the UK, in spite of a previous very successful programme to get industry to reduce the amount of salt they add to food, this policy has been stalled by lack of government action in forcing the industry to reduce salt further. The Department of Health and Social Care, which has taken over Public Health England’s responsibility in this area, needs to urgently act to get the food industry to reduce the amount of salt they add to food and save the maximum number of people dying unnecessarily from stroke.” 

Sonia Pombo, Campaign Manager at Action on Salt, says:  

“We are all eating too much salt, but many of us are completely unaware of this, or the damage it is having on our health. Potassium salts have long been shown to be a safe alternative to salt[1], and even have the potential to benefit us long term by reducing our blood pressure, as demonstrated in this study. With the majority of our salt intake coming from ready-made foods, we urge the food industry to take note and act fast without further delay.” 


[1] SACN-COT review on potassium-based sodium replacers conclude that any potential risk to consumption of potassium based salts is outweighed by the benefits on population health.                            




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