Replacing part of the salt – sodium chloride – with potassium chloride could restore almost 70 million years of healthy life, globally, preventing more than 10 million new cases di malattie cardiovascolari e renali croniche. La stima proviene uno studio pubblicato su Nature Health il 4 novembre 2026 (Huang et al., 2026), che apre prospettive concrete per la prevenzione e per la riformulazione degli alimenti.
However, the supply of salt with potassium remains marginal in Italy, mostly confined largely to foods for special medical purposes and in any case far from the mixture covered by the aforementioned study, as emerges from the comparison between 8 products on the market. New perspectives therefore open up not only for innovation in the category but also for the reformulation of a wider range of processed foods.
Sodium and potassium, a balance to be rebuilt
THE'average intake daily of sodium, globally, is about 4.3 grams per day – equivalent to approx 10.8 grams of salt – more than double the limit of 2 grams of sodium per day (about 5 grams of salt) recommended by the World Health Organization. That of potassium vice versa it stops at 2.3 grams, 34.3% below the minimum of 3.5 grams indicated by the same Organization (Huang et al., 2026). The excess of the former and the deficiency of the latter contribute to increasing blood pressure, the first modifiable risk factor for cardiovascular and renal diseases.
In Italy the Istituto Superiore di Sanità, in the 2023-2025 CUORE Project survey, found an average salt consumption of 9.3 grams per day in men and 7.2 grams in women. 49% of men and 37% of women, not surprisingly, have high blood pressure levels (ISS, 2025).
Reducing salt requires accepting a less intense flavor, and this obstacle has so far proved difficult for consumers and the industry to overcome. The salt enriched with potassium Instead, it acts on two fronts - it decreases sodium and increases potassium - without differences in taste perceivable by most people. In the 2025 the World Health Organization (WHO) suggested, with a conditional recommendation, replacing common table salt with reduced-sodium substitutes containing potassium. The recommendation concerns adults of the general population, with the exclusion of pregnant women, children and people with impaired renal function (WHO, 2025).
The study design
La ricerca, coordinata dal George Institute for Global Health di Sydney con università di Stati Uniti, Paesi Bassi, Cina, Regno Unito e Svezia, adotta un modello di comparative risk assessment. Considera circa 4,6 miliardi di adulti dai 25 anni in su, in 193 Paesi e territori. Il modello collega in sequenza:
– replacing common salt with a mixture of 75% sodium chloride and 25% potassium chloride;
– the potential variation in sodium and potassium intake in each country;
– the consequent reduction in systolic blood pressure;
– reducing the risk of cardiovascular and chronic kidney disease;
– the estimation of potential adverse effects from hyperkalemia in people with chronic kidney disease in stages G3-G5.
There proportion 75/25 (NaCl/KCl) è quella con le prove più solide di efficacia e accettabilità. Nel più ampio e lungo studio clinico condotto finora, il 92% dei partecipanti la utilizzava ancora dopo cinque anni. Le stime derivano da dati aggregati già pubblicati, in particolare il Global Burden of Disease 2021. L’incertezza è stata quantificata con 1.000 simulazioni Monte Carlo (Huang et al., 2026).
Lo studio clinico in questione è il Salt Substitute and Stroke Study, condotto in 600 villaggi della Cina rurale su 20.995 persone over-60, in larga parte ipertese o con precedenti di ictus. Food Times ne aveva illustrato i risultati nel 2021: la sostituzione del sale con la miscela 75/25 aveva ridotto i casi di ictus, gli eventi cardiovascolari e la mortalità prematura, senza evidenze di un aumento dei rischi di iperpotassiemia (Dongo and Della Penna, 2021).
The scenarios examined are five:
– complete replacement of salt, domestic and contained in processed foods and catering;
– replacement of only discretionary salt, added at home during preparation and at the table;
– replacement of only non-discretionary salt, contained in processed foods and served outside the home;
– discretionary salt replacement only in people diagnosed with hypertension;
– discretionary salt replacement only in people being treated for hypertension.
Estimated health benefits
In the full replacement scenario, the model estimates every year 10.17 million new cases fewer cardiovascular and chronic kidney diseases, with a 95% uncertainty interval of 9.59-10.70 million. They add 69.43 million years of life lost or experienced with disability (DALYs) that could be recovered. It would especially benefit people at risk of ischemic heart disease, hypertensive heart disease, stroke and chronic kidney disease. The overall burden of these pathologies could decrease by 13.1% for new cases and by 16.5% for years of healthy life. Attributable annual mortality would be reduced by 14.6%, equal to 2.96 million deaths (Huang et al., 2026).
In 133 out of 193 countries, mostly in Asia, North America and Latin America, substitution could contribute to prevention at least one tenth of cardiovascular mortality. About 40% of the benefits would concern women. Even partial strategies would offer relevant results.
| Scenario | New cases of cardiovascular and chronic kidney disease avoided every year |
| Replacing all the salt | 10.17 million |
| Discretionary salt only (household use) | 6.19 million |
| Non-discretionary salt only (processed foods and restaurants) | 5.46 million |
| Discretionary salt only, people with diagnosed hypertension | 1.72 million |
| Discretionary salt only, people with treated hypertension | 1.41 million |
Source: Huang et al., 2026; George Institute for Global Health, 2026. Partial scenarios are alternatives and estimates should not be added.
The role of processed foods and catering
In Europe and the United States beyond 70% of the salt consumed comes from processed foods and eating out (Huang et al., 2026). For high-income countries, industrial reformulation therefore weighs more than domestic choices. According to the authors, its weight is destined to grow everywhere, as economic development is accompanied by diets based on processed foods.
Gli autori richiamano la valutazione del Committee on Toxicity del Regno Unito, secondo cui la replacement up to 25-30% of the salt with potassium chloride is feasible and safe in most food categories. However, this is not a general green light, since salt plays a role technological functions ulteriori rispetto a quella sensoriale: conservazione, struttura, gestione dell’acqua e, in diverse categorie, sicurezza microbiologica. Ogni riformulazione richiede quindi verifiche prodotto per prodotto su caratteristiche sensoriali, stabilità, sicurezza e shelf life. Le categorie più interessate sono prodotti da forno, pane, salumi e prodotti a base di carne, piatti pronti, salse e condimenti, ristorazione collettiva.
Safety of use and consumers to be protected
The increase in potassium requires caution in people with advanced chronic kidney disease and in those taking drugs that can raise blood potassium. In these cases, excess potassium can cause hyperkalemia, which is dangerous for the heart rhythm.
The study quantifies the balance between benefits and risks. Among the 239 million adults with chronic kidney disease in stages G3-G5, complete replacement could help prevent approximately 750,000 cardiovascular deaths per year by reducing blood pressure. It could instead contribute to approximately 100,000 deaths from hyperkalemia. The ratio is more than seven to one (Huang et al., 2026).
The authors point out that this harm has never been demonstrated in clinical studies and the estimate is most likely overestimated, since it assumes that no person at risk is excluded from use. There are four measures indicated to reduce the risk:
– migliorare lo screening della malattia renale cronica;
– apply standardized warnings on potassium-enriched salt packages;
– indicate potassium-enriched salt in the list of ingredients of foods that contain it;
– report the potassium content in the nutritional information.
The limitations of the study
The study consists of modeling, not an experiment on 193 populations. The starting data dates back to a few years ago and the distribution between discretionary and non-discretionary salt is uncertain in many countries. The relationship between potassium and blood pressure is less documented than that between sodium and blood pressure, especially in non-hypertensive people. The model also photographs a single moment and does not take into account future demographic changes. The transition would take decades and the estimated benefits are not immediately achievable (Huang et al., 2026).
However, sensitivity analyzes confirm this significant benefits even with conservative assumptions. With a halved replacement, approximately 1.72 million deaths per year could be avoided. With a replacement of one fifth, around 700,000 would be avoided. Relevant benefits also result with one lighter mixture, 15% potassium chloride.
Salts with potassium, the offer in Italy
In the wake of comparison between 15 iodized salts già pubblicato su GIFT, abbiamo esaminato l’offerta di sale con potassio. La rilevazione è stata eseguita il 6 novembre 2026 sulle schede prodotto disponibili online di Carrefour, Coop, Esselunga e Conad e su alcune farmacie online. Abbiamo individuato 8 prodotti con etichetta consultabile. Il sale iposodico iodato ‘Cuore’ compare nell’assortimento, ma la sua scheda online non riporta ingredienti né valori nutrizionali e viene pertanto escluso dal confronto.
| Product (format) | Channel | Sodium g/100 g | Potassium g/100 g | Iodine | Other ingredients and additives | Framework | Price noted |
| Novosal Céréal, Nutrition & Santé Italia (200 g) | Carrefour, Conad, pharmacies | 13,6 | 28,5 | No | potassium citrate, magnesium sulphate and carbonate, calcium carbonate | food for special medical purposes | €2.79 (€13.95/kg) Carrefour; €3.30 (€16.50/kg) Conad |
| Novosal iodized (200g) | Carrefour, Conad, pharmacies | 13,6 | 28,5 | 3 mg/100 g | as above, potassium iodate | food for special medical purposes | €3.79 (€18.95/kg) Carrefour; €3.50 (€17.50/kg) Conad |
| Hyposal iodized low sodium salt, Italkali (200 g) | Esselunga | 12,3 | 32 | 3 mg/100 g | magnesium sulphate and carbonate, E 536 | dietary salt for low-sodium diets | not detected |
| Well yes iodized low-sodium salt, Coop (200 g) | Coop | 12,3 | 32,4 | 3 mg/100 g | potassium chloride 62%, sodium chloride 31.2%, magnesium sulphate and carbonate, E 536 | food for special medical purposes | not detected |
| Liking yourself Conad iodized low-sodium salt (200 g) | Conad | 12,3 | 32 | 300 µg/100 g declared (3 mg calculated) | potassium chloride 62.2%, sodium chloride 31.2%, magnesium sulphate and carbonate, potassium iodate, E 536 | food for special medical purposes | €2.25 (€11.25/kg) |
| Carrefour Classic low sodium salt (200 g) | Carrefour | 13,6 | 30 | No | potassium chloride 62%, sodium chloride 26.5%, magnesium sulphate and carbonate | food for special medical purposes | €1.99 (€9.95/kg) |
| SaleSohn (150g) | pharmacies | 13,6 | 25 | No | potassium citrate, magnesium sulphate, glutamic acid, magnesium and calcium carbonates | low-sodium dietary salt | not detected |
| Essential Sea Gem -50% sodium, CIS (125 g) | online pharmacies | approximately 19.6 | 21,5 | No | sea salt, marine minerals (potassium, magnesium, calcium), magnesium oxide, E 535, magnesium carbonate | commonly used food | not detected |
Note: Carrefour products were not available online on the date of the survey. For Gemma Essenziale sodium is calculated from the declared 'salt' value, equal to 49 g/100 g.
Composition. Seven out of eight products provide 12.3-13.6 grams of sodium per 100 grams; where declared (Coop, Carrefour, Conad) potassium chloride is equal to 62-62.2%. Common table salt, almost pure sodium chloride, provides about 39 grams. The sodium reduction is therefore 65-70%. Potassium instead rises to 25-32.4 grams, almost double or more compared to the approximately 13 grams of the 75/25 mixture. Only Gemma Essenziale is placed in an intermediate position, with a sodium reduction of approximately half and 21.5 grams of potassium.
Foods for special medical purposes. Cinque sali su otto vengono presentati come alimenti a fini medici speciali, destinati alla gestione dietetica dell’ipertensione, e riportano avvertenze sull’uso sotto controllo medico, come ‘da utilizzarsi sotto controllo medico’. La formula citata è quella di Coop Bene Sì, mentre Novosal, Carrefour e Piacersi Conad impiegano diciture analoghe. L’impostazione italiana segue i criteri del ministero della Salute, esaminati più avanti, e confina il sale con potassio all’ambito clinico. Gli scenari che lo studio indica come più vantaggiosi e la raccomandazione dell’Organizzazione Mondiale della Sanità riguardano invece la popolazione adulta in generale. Gemma Essenziale è l’unico prodotto proposto per l’uso familiare, accompagnato dall’avvertenza ‘Sconsigliato per persone che seguono un regime alimentare povero in potassio’.
Iodine and additives. Four products are iodized, with 3 mg of iodine per 100 grams, the same content as iodized salt. Iposal, Bene Sì and Piacersi Conad contain the anti-caking agent E 536 (potassium ferrocyanide), Gemma Essenziale E 535 (sodium ferrocyanide). Potassium chloride is in turn authorized as a food additive with the acronym E 508 (EC regulation 1333/2008, Annex II).
Consistency of information. The Carrefour Classic online sheet declares sodium chloride at 26.5% and sodium equal to 13.6 grams per 100 grams. However, the two values do not appear consistent, given that 26.5 grams of sodium chloride provide approximately 10.4 grams of sodium. The Coop sheet expresses chloride and potassium in milligrams, which are instead present in the order of tens of grams. The Piacersi Conad data sheet declares potassium iodate at 0.005%, equal to approximately 3 mg of iodine per 100 grams, but reports 300 µg in the nutritional table.
Formats and prices. The packages range from 125 to 300 grams, far from the 1 kg formats of common salt, and the pharmaceutical sales channel has a significant impact. For products with a recorded price, the price ranges from 9.95 to 18.95 euros per kg. The study indicates that worldwide, potassium-enriched salt costs on average twice as much as common salt (Huang et al., 2026).
The regulatory framework
Foods for special medical purposes
In Italy, the Ministry of Health guidelines on Foods for special medical purposes qualify as hyposodium salts salt substitutes with a sodium chloride content between 20 and 35%, equal to 7.8-13.6 grams of sodium per 100 grams. The ratio of potassium to sodium should not be less than 1.5:1, and it is advisable that potassium does not exceed approximately one third of the total weight. The label must include sodium, potassium and the main minerals deriving from the replacement salts per 100 grams.
THE'indication è ‘gestione dietetica dell’ipertensione arteriosa e altre condizioni mediche richiedenti una marcata contrazione dell’apporto alimentare di sodio’ (ministero della Salute, Linee guida sugli alimenti a fini medici speciali, revisione del 15 luglio 2025, punto 7.2.9).
Food for special medical purposes must report in label, among the additional mandatory indications, the wording on use under medical supervision (EU regulation 609/2013, art. 2.2, letter 'g'; EU delegated regulation 2016/128, art. 5.2, letter 'a').
All the low-sodium salts in the comparison, seven out of eight, respect the minimum potassium/sodium ratio, between 1.8 and 2.6, and the limit of one third of the weight for potassium. Gemma Essenziale, a commonly used food, falls outside these parameters, with a ratio of approximately 1.1:1.
Commonly used foods
A mixture 75/25 like the one examined in the current study, it provides approximately 29.5 grams of sodium per 100 grams. It is therefore outside the range of low sodium salts and falls among them Commonly used foods. In this case the general rules on nutritional and health claims apply:
– l’indicazione ‘with reduced sodium/salt content‘ richiede una riduzione di almeno il 25% rispetto a prodotti simili, soglia che la miscela 75/25 raggiunge su misura (reg. CE 1924/2006, Allegato);
– con circa 13 grammi di potassio per 100 grammi, il prodotto può riportare il nutrition claim ‘source of potassium' and may bear the authorized indication on the contribution of potassium to the maintenance of normal blood pressure, in compliance with the conditions of use and information provided (EU regulation 432/2012, Annex).
In the nutritional declaration, 'salt' corresponds to sodium multiplied by 2.5 (EU regulation 1169/2011, Annex I, point 11). Substitution with potassium chloride therefore reduces the declared value. Potassium, however, can only be indicated if it reaches 15% of the nutritional reference value, equal to 300 mg per 100 grams (EU regulation 1169/2011, Annex XIII, part A, points 1-2).
Questo vincolo rileva sulla trasparenza raccomandata dagli autori. Un pane con 1,5 grammi di sale per 100 grammi ove un quarto del sale venga sostituito con cloruro di potassio contiene circa 0,375 grammi di cloruro di potassio e quindi circa 200 mg di potassio. È il 10% del valore di riferimento, al di sotto la soglia che ne consente la dichiarazione in etichetta sotto forma di nutrition claim. In questi casi l’informazione al consumatore passa solo attraverso l’elenco degli ingredienti.
Indications for operators
The study offers the food industry an opportunity for innovation with a measurable health benefit. To grasp it, a few steps are needed:
– evaluate the technological feasibility of replacing part of the sodium with potassium, category by category, with sensorial, microbiological and stability tests;
– verify the legal classification of the product – food in common use or food for special medical purposes – based on the composition and conditions of use;
– construct nutritional and health claims that comply with authorized texts and conditions of use;
– consider the possible opportunity of a warning aimed at people who follow a diet low in potassium.
Our division DO (Food and Agriculture Requirements) supporta gli operatori e i consorzi, anche di ricerca, nella pianificazione strategica della compliance nell’innovazione produttiva e nell’informazione commerciale. Le attività comprendono i profili di sicurezza di processi e prodotti, eventuali autorizzazioni, nutrition & health claim, asserzioni ambientali, e si estendono allo sviluppo di sistemi di governance aziendale e procedure operative.
Dario Dongo
References
European Union regulatory sources
Regulation (EC) No 1924/2006 of the European Parliament and of the Council of 20 December 2006 on nutrition and health claims made on foods. Consolidated text: 12/13/2014. http://data.europa.eu/eli/reg/2006/1924/2014-12-13
Regulation (EC) No 1333/2008 of the European Parliament and of the Council of 16 December 2008 on food additives. Consolidated text: 08/18/2026. http://data.europa.eu/eli/reg/2008/1333/2026-08-18
Regulation (EU) No 1169/2011 of the European Parliament and of the Council of 25 October 2011 on the provision of food information to consumers. Consolidated text: 04/01/2025. http://data.europa.eu/eli/reg/2011/1169/2025-04-01
Commission Regulation (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods, other than those referring to the reduction of disease risk and to children's development and health. Consolidated text: 08/20/2025. http://data.europa.eu/eli/reg/2012/432/2025-08-20
Regulation (EU) No 609/2013 of the European Parliament and of the Council of 12 June 2013 on food intended for infants and young children, food for special medical purposes, and total diet replacement for weight control. Consolidated text: 01/09/2025. http://data.europa.eu/eli/reg/2013/609/2025-09-01
Commission Delegated Regulation (EU) 2016/128 of 25 September 2015 supplementing Regulation (EU) No 609/2013 of the European Parliament and of the Council as regards the specific compositional and information requirements for food for special medical purposes. Consolidated text: 07/15/2021. http://data.europa.eu/eli/reg_del/2016/128/2021-07-15
Institutional sources
Istituto Superiore di Sanità, EpiCentro. (2025, 31 ottobre). Giornata mondiale dell’ictus 2025. Archivio 2025, area cardiovascolare. https://www.epicentro.iss.it/cardiovascular/2025
Ministero della Salute. (2025). Linee guida sugli alimenti a fini medici speciali (AFMS). Revisione del 15 luglio 2025. https://www.salute.gov.it/new/it/tema/alimenti-fini-medici-speciali-ed-integratori/alimenti-fini-medici-speciali/
The George Institute for Global Health. (2026, 4 novembre). A healthier form of salt could prevent millions of deaths from stroke and heart disease [comunicato stampa]. https://www.georgeinstitute.org/news-and-media/news/a-healthier-form-of-salt-could-prevent-millions-of-deaths-from-stroke-and-heart-disease
World Health Organization. (2025, 27 gennaio). Use of lower-sodium salt substitutes: WHO guideline. https://www.who.int/publications/i/item/9789240105591
Scientific literature
Huang, L., Xu, X., Matsushita, K., Brady, T. M., Appel, L. J., Hoorn, E. J., Schutte, A. E., Wu, J. H. Y., Tian, M., Aminde, L. N., Trieu, K., Neal, B., & Marklund, M. (2026). Global health outcomes from replacing dietary sodium chloride with potassium-enriched salt. Nature Health. Pubblicato online il 4 novembre 2026. https://doi.org/10.1038/s44360-026-00216-9
Related articles
Dongo, D., & Della Penna, A. A. (2021, 4 settembre). Sale di potassio per ridurre la pressione e i rischi cardiovascolari. Studio clinico su 21 mila over-60. Food Times. https://www.foodtimes.eu/it/ricerca/sale-di-potassio-per-ridotto-la-pressione-e-i-rischi-cardiovascular-studio-clinico-su-21-mila-over-60/
Strinati, M. (2026, 26 settembre). Sale iodato, 15 a confronto tra granelli di mare e di miniera. GIFT. https://www.greatitalianfoodtrade.it/notizie/sale-iodato-investigation-di-mercato/
Product data sheets consulted on 6 November 2026
Carrefour. Carrefour Classic Low Sodium Salt 200 g. https://www.carrefour.it/p/carrefour-classic-sale-iposodico-200-g/8012666075522.html
Carrefour. Céréal Novosal Low sodium salt 200 g. https://www.carrefour.it/p/cereal-novosal-sale-iposodico—-200-g/8018031447505.html
Carrefour. Céréal Novosal Iodised low-sodium salt 200 g. https://www.carrefour.it/p/cereal-novosal-sale-iposodico-iodato-da-cucina-gestion-dietetica-dell- hypertension—200-g/3175681052345.html
Conad. Céréal Novosal Low sodium salt 200 g. https://spesaonline.conad.it
Conad. Céréal Novosal Iodised low-sodium salt 200 g. https://spesaonline.conad.it
Conad. Piacersi Conad Iodised Low Sodium Salt 200 g. https://spesaonline.conad.it
Coop. Good Yes Iodised low sodium salt 200 g. https://www.coop.it/il-dotto-coop/bene-si/salse-condimenti-e-conserve/alimentari-confezionati/preparati-brodo-e
Esselunga. Iposal Iodised hyposodium salt 200 g. https://spesaonline.esselunga.it/commerce/nav/supermercato/store/prodotti/371070/iposal-sale-iposodico-iodato-200-g
Code. SaleSohn low sodium salt 150 g. https://www.codifa.it/parafarmaci/s/salesohn-alimenti-dietetici-iposodici
1000Pharmacies. Gemma di Mare Gemma Essenziale salt -50% sodium 125 g. https://www.1000farmacie.it/gemma-di-mare-gemma-esseenziale-sale-50-di-sodio-125-g.html
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT – Food Times) and Égalité.
