Experts share recommendations on use of potassium enriched low sodium salt substitutes

The public health strategy aims to address high blood pressure and heart disease in India

Experts from clinical medicine, public health, and nutrition released a consensus statement recommending potassium-enriched low-sodium salt substitutes (LSSS) as an effective, intervention to reduce hypertension and cardiovascular disease in India.

The consensus emerged from a conference organised by The George Institute for Global Health India in collaboration with Resolve to Save Lives on December 2, 2025. The organisations later launched the Consensus Statement on potassium enriched low-sodium salt substitutes through a national webinar, bringing together policymakers, clinicians, nutritionists and public health leaders to deliberate upon the ways to accelerate the adoption and use of potassium-enriched low sodium salt substitutes.

Prof Vivekanand Jha, Executive Director, The George Institute for Global Health India, highlighted the strength of the evidence supporting LSSS’s role in reducing adverse cardiovascular disease outcomes. He said, “High-quality research shows India’s high sodium and low potassium intake is a key driver of hypertension and cardiovascular disease. Low-sodium salt substitutes address both—cutting sodium and restoring potassium, which is key to lowering blood pressure. With no change in taste and appropriate safeguards, this is a safe, scalable solution for India’s NCD prevention strategy.”

Dr Syed Imran Farooq, Executive Director, Resolve to Save Lives, India, said, “Reducing excess sodium intake is one of the most impactful and achievable steps India can take to prevent hypertension and cardiovascular disease at scale. Evidence shows potassium – enriched low-sodium salt substitutes are a practical, effective, and scalable solution, and this consensus marks an important shift from evidence to action, aligned with the Government of India’s commitment to reduce population-level salt intake. At Resolve to Save Lives, we believe in advancing practical, scalable solutions that can improve health at population level. This consensus builds momentum to reduce salt intake, improve heart health, and accelerate progress toward national NCD goals. Together, we can turn evidence into action and save lives.”

A growing body of global and Indian evidence demonstrates that potassium-enriched low-sodium salt substitutes (LSSS) can significantly reduce blood pressure and prevent adverse cardiovascular events.

● A randomised controlled trial in rural India (2021) involving adults with hypertension demonstrated a 4.6 mm Hg reduction in systolic blood pressure among those using potassium enriched LSSS.
● A large-scale cluster randomized trial (SSaSS, China, ~21,000 participants over ~5 years) showed significant reductions in stroke (14 per cent), major cardiovascular events (13 per cent), and overall mortality (12 per cent) among individuals using potassium enriched LSSS.
● Modelling studies estimate that nationwide adoption of LSSS in India could prevent 8–14 per cent of cardiovascular deaths annually, highlighting its population-level impact.

Experts noted that potassium is safe for most people, including many with early-stage kidney disease, and that caution is primarily necessary for individuals with advanced stages of kidney disease or when potassium levels are already high.

Dr Sailesh Mohan, Deputy Director, Centre for Chronic Disease Control, Delhi, said, “We also recommend that governments should support public procurement for school mid-day meals, ICDS, PDS rations, hospital kitchens, railways, and large institutional canteens to build volume and normalise use. Food industry reformulation policies should require partial replacement of sodium chloride with potassium salts in packaged foods and restaurant meals, especially in high-salt categories such as snacks, instant mixes, and condiments.”

Dr Meenakshi Sharma, Formerly Scientist G, NCD Division, ICMR, said, “To effectively scale low-sodium salt substitutes (LSSS) in India, there is a need for dedicated trials in high-risk populations, alongside modelling studies to assess their benefits, risks, and trade-offs across diverse groups. Cluster trials and qualitative research can further help evaluate different delivery approaches. Strengthening this evidence base will be critical to informing public procurement strategies and policy decisions for wider adoption.”

The consensus recommends the following priority actions for India:
● Policy Integration: Include potassium enriched LSSS in national sodium reduction strategies, hypertension and NCD guidelines, and update FSSAI standards to enable the safe, widespread use of potassium enriched LSSS as edible salt.

● Focus on Everyday Use: Prioritise replacing regular salt with potassium enriched LSSS in homes and in government nutrition programmes and institutional kitchens, while requiring food industry reformulation to use potassium enriched LSSS in high salt packaged foods and restaurant meals.

● Drive Awareness: Drive behaviour changes through social marketing that builds familiarity, trust, and demand, using simple messages reinforced by visuals, endorsements from health leaders, and community outreach demonstrating the value of potassium enriched LSSS use and addressing common myths.

● Health System Linkages: Build capacity of healthcare professionals to make potassium enriched LSSS a routine part of hypertension prevention and care, with simple screening to identify those who should avoid potassium and clear guidance for others to switch all household salt to potassium enriched LSSS.

● Further Research: Generate more evidence for high-risk groups such as CKD patients and study real-world implementation in India.

Prof Ambuj Roy, Department of Cardiology, AIIMS, New Delhi, said, “While we have enough scientific data supporting the benefits of Low-Sodium Salt Substitutes, the evidence-to-action gap must be closed by treating LSSS as a ‘ dietary vaccine’ to treat hypertension. It is the ‘low-hanging fruit’ of cardiology, a passive intervention that provides 24/7 cardiovascular protection without requiring patients to actually sacrifice the taste of their traditional diet.”

Dr Sachdev Meenakshi, Dietician, Tamil Nadu Govt. Multi Super Speciality Hospital, Chennai, said, “Despite strong evidence and top-tier guideline recommendations, low-sodium salt substitutes remain underutilised in practice. With hypertension affecting a significant proportion of India’s population, we need an ‘all hands-on deck’ approach to bridge this gap. This means moving beyond awareness to active prescription, wider clinical adoption, and integration into medical and dietetic training, public programmes, and early health education. It’s a simple, effective intervention—we now need to ensure it reaches people at scale”.

Dr Sandeep Mahajan, Professor, Nephrology, AIIMS, New Delhi, said, “The potential risks of low-sodium salt substitutes are often overstated relative to their population-level benefits. While a small subset of patients—particularly those with advanced kidney disease or on specific medications—require caution, this group is clearly identifiable and can be guided through simple screening and labelling measures. With clear advisories and better awareness, nearly 90% of the population can safely benefit from this intervention. What we need to address now is therapeutic inertia—both among clinicians and the public—to enable wider adoption of this effective strategy for reducing cardiovascular risk.

Experts emphasised that India has a unique opportunity to achieve large-scale reductions in hypertension and cardiovascular disease by targeting salt use in homes, which contributes to the majority of sodium intake. Scaling up the use of potassium-enriched LSSS could therefore deliver substantial population-level health gains, including reduced blood pressure, fewer strokes and heart attacks, and lower premature mortality.