Published Apr 22, 2026 | 7:00 AM ⚊ Updated Apr 22, 2026 | 7:00 AM
Representational image. Credit: iStock
Synopsis: India’s scientists and doctors are urging a nationwide switch to low-sodium, potassium-enriched salt to combat hypertension and heart disease. Evidence shows it lowers blood pressure, reduces strokes, and prevents cardiovascular deaths without altering taste. While safe for most, caution is advised for advanced kidney disease. Experts call for subsidies, wider access, and regulatory support to scale adoption.
A grain of salt may seem like an unlikely starting point for a public health revolution. But leading scientists across India now argue that swapping regular table salt for a potassium-enriched version could prevent hundreds of thousands of deaths from heart disease every year, without asking people to change how their food tastes.
On 17 April 2026, The George Institute for Global Health India and Resolve to Save Lives released a consensus statement backed by cardiologists, nephrologists, nutritionists, and public health researchers from across the country. The message was direct: India has a salt problem, and a practical, affordable fix exists.
The substitute looks, pours, and tastes like ordinary salt. The difference lies in its composition. Where regular salt contains 100 percent sodium chloride, the low-sodium salt substitute (LSSS) replaces 25 to 30 percent of that sodium with potassium chloride.
That single change does two things simultaneously. It reduces sodium intake, the mineral most strongly linked to elevated blood pressure. It also increases potassium, which helps the body excrete sodium and relaxes blood vessels. Most Indians get far too little of both benefits.
The white paper released alongside the consensus notes that potassium intake among Indians sits at roughly 1,400 to 1,800 mg/day, less than half the WHO-recommended 3,500 mg. Sodium intake, meanwhile, runs between 8 and 11 grams of salt daily, nearly double the WHO ceiling of 5 grams. Roughly 80 percent of that sodium enters Indian diets through salt added during home cooking.
That last figure is what makes this intervention particularly well-suited to India. Unlike high-income countries, where processed and packaged foods drive sodium consumption, India’s problem sits largely in the kitchen.
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The evidence base has strengthened considerably over the past five years. A randomised controlled trial conducted in rural Telangana demonstrated that hypertensive adults who switched to the substitute reduced their systolic blood pressure by 4.6 mmHg.
A larger Chinese trial involving approximately 21,000 participants over nearly five years found even more striking results: users recorded 14 percent fewer strokes, 13 percent fewer major cardiovascular events, and 12 percent lower overall mortality.
Crucially, researchers later modelled where those cardiovascular gains actually came from. Analysis of the Chinese trial data showed that approximately 75 percent of the blood pressure-lowering effect came from the potassium increase, not the sodium reduction alone. The substitute, in other words, works primarily by correcting a deficiency most Indians do not know they have.
Modelling studies then applied those findings to India’s population. The white paper estimates that nationwide adoption could prevent 8 to 14 percent of cardiovascular deaths annually, amounting to tens of thousands of lives.
Prof Vivekanand Jha, Executive Director of The George Institute for Global Health India, described the intervention as both proven and practical.
“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.”
Prof Ambuj Roy from the Department of Cardiology at AIIMS New Delhi went further, arguing that the medical community has been slow to act on evidence that already justifies routine use. He described LSSS as “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.”
The consensus does not recommend the substitute for everyone without qualification. People with advanced chronic kidney disease (stages 4 and 5) struggle to excrete potassium efficiently, and increased intake carries real risks for that group. Those on potassium-sparing diuretics or potassium supplements also require caution.
However, the panel pushed back against what it described as excessive restriction. Adults with early-stage kidney disease, diabetics, elderly patients, and those on ACE inhibitors or angiotensin receptor blockers should not be routinely excluded, the consensus concluded. Current evidence does not support blanket restrictions for those groups.
Prof Sandeep Mahajan, Professor of Nephrology at AIIMS New Delhi, argued that the medical profession has allowed theoretical risks to overshadow a substantial population-level benefit.
“The potential risks of low-sodium salt substitutes are often overstated relative to their population-level benefits. 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.”
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Scientists backing the substitute acknowledge it faces real obstacles before it reaches the households that need it most.
The product currently sells at two to four times the price of regular iodised salt. Availability concentrates in metropolitan centres, with approximately 70 percent of all LSSS sold in Delhi, Mumbai, Bengaluru, and Pune combined. Rural markets, where hypertension burdens run high and awareness runs low, remain largely unreached.
The white paper identifies the cost of imported potassium chloride as the primary driver of that price gap, accounting for 60 to 75 percent of total production costs. The consensus calls on the government to reduce GST on the product and introduce production subsidies to bring costs down.
Dr Sailesh Mohan, Deputy Director of the Centre for Chronic Disease Control in Delhi, argued that government procurement could reshape the market from the top down.
“We 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.”
The panel also called on India’s food safety regulator, FSSAI, to formally recognise potassium-enriched iodised salt as an approved edible salt category. A draft FSSAI warning label currently describes the product as one “to be consumed under medical supervision,” language the consensus describes as too restrictive for a general population that stands to benefit from wider use.
Dr Syed Imran Farooq, Executive Director of Resolve to Save Lives India, framed the moment as a turning point.
“Reducing excess sodium intake is one of the most impactful and achievable steps India can take to prevent hypertension and cardiovascular disease at scale. This consensus marks an important shift from evidence to action. Together, we can turn evidence into action and save lives.”
