New Delhi: A recent report released on January 26, 2025, the World Health Organization (WHO) has called for reducing sodium intake to less than 2 g/day while also recommending using lower-sodium salt substitutes, including those with potassium, to address the increasing global burden of hypertension, cardiovascular diseases, and strokes linked to high salt consumption.
Each year, poor diet contributes to 8 million deaths worldwide, with 1.9 million linked to excessive sodium consumption. Lowering sodium intake is a proven strategy to reduce the risk of noncommunicable diseases (NCDs) like cardiovascular disease and chronic kidney disease by helping control blood pressure. Additionally, reducing sodium can lower the risk of other health conditions associated with high intakes, such as gastric cancer.
The World Health Organization (WHO) has released a new guideline recommending the use of lower-sodium salt substitutes (LSSS) to help reduce sodium intake and the risk of cardiovascular diseases. The guideline comes as global sodium intake remains high, with an estimated average of 4.3 grams per day in 2019, more than double the WHO's recommended limit of less than 2 grams per day. Specifically the guideline states
"To reduce blood pressure and risk of cardiovascular diseases, WHO has recommended reducing sodium intake to less than 2 g/day (strong recommendation).4 In this context, using less regular table salt 5 is an important part of an overall sodium reduction strategy. If choosing to use table salt, WHO suggests replacing regular table salt with lower-sodium salt substitutes that contain potassium (conditional recommendation).6 This recommendation is intended for adults (not pregnant women or children) in general populations, excluding individuals with kidney impairments or with other circumstances or conditions that might compromise potassium excretion"
The primary goal of the new guidelines is to reduce blood pressure and the risk of cardiovascular diseases by reducing sodium intake. High sodium intake is associated with 1.9 million deaths annually. The WHO guideline suggests that adults can replace regular table salt with LSSS, which contains less sodium and often includes potassium chloride (KCl) to maintain a similar flavor.
Sodium Intake: Adults should limit sodium consumption to less than 2 grams per day (5 g/day salt) to help lower blood pressure and reduce the risk of cardiovascular diseases. This is a strong recommendation. Salt Substitutes: If using table salt, adults may opt for low-sodium salt substitutes (LSSS) containing potassium. Adults may consider using low-sodium salt substitutes (LSSS) containing potassium; however, if any household member, including children or pregnant women, is at risk of hyperkalemia. WHO notes, "If a member in a household (including children and pregnant women)is at risk for hyperkalaemia, LSSS should not be used to prepare a family meal to be eaten by the member"
Scope of Use: The recommendation specifically applies to the discretionary use of LSSS as table salt and does not extend to condiments, processed foods, or restaurant meals. Target Population: These guidelines apply to the general adult population but exclude children, pregnant women, and individuals with kidney issues or conditions affecting potassium excretion. Children’s Sodium Intake: Children should also reduce sodium intake to help manage blood pressure, with their daily limit adjusted proportionally based on energy requirements.
The blood-pressure-lowering benefits of LSSS are largely attributed to their potassium content. In line with this, WHO also emphasizes the importance of increasing potassium intake from natural food sources such as beans, peas, nuts, and leafy green vegetables to further support blood pressure control and cardiovascular health.
While LSSS use caused a slight average increase of 0.12 mmol/L in blood potassium levels, it had minimal to no impact on the incidence of hyperkalemia (high potassium levels). However, the studies did not include individuals with kidney disease or other conditions that could make increased potassium intake harmful.
Key Considerations for Implementation
WHO’s recommendation on low-sodium salt substitutes (LSSS) is conditional, as the overall certainty of evidence remains low, and concerns persist about the balance between benefits and potential risks, particularly in populations with undiagnosed health conditions. Since LSSS still contain sodium, their use should result in a net reduction in sodium intake compared to the regular salt they replace. The guideline does not extend to children or pregnant women due to insufficient data on these groups. Additionally, LSSS should be introduced in settings with adequate healthcare access to ensure that conditions that could make increased potassium intake harmful are properly diagnosed and managed. To align with national public health policies, steps should be taken to ensure LSSS is iodized, maintaining essential iodine intake.
Challenges and Future Directions
The widespread adoption of low-sodium salt substitutes (LSSS) faces several challenges, including higher costs, limited awareness, taste preferences, and skepticism about their health benefits.
WHO acknowledges these barriers and highlights the need for further research, particularly on the safety and efficacy of LSSS in children and pregnant women, as well as their long-term impact on sodium and potassium intake.
While LSSS offers potential health benefits, WHO emphasizes that the primary strategy should be reducing overall sodium intake from both discretionary (table salt) and non-discretionary (processed foods) sources. This guideline aligns with WHO’s broader efforts to combat non-communicable diseases (NCDs) and achieve the global goal of a 30% reduction in average sodium consumption by 2030. To support member states in this initiative, WHO provides resources such as the SHAKE Technical Package for Salt Reduction and global sodium benchmarks for various food categories, helping governments implement effective sodium reduction policies.
You can read the full report here: https://iris.who.int/bitstream/handle/10665/380227/9789240105591-eng.pdf?sequence=