Episode 13: 2025 WHO Guidelines on Low Sodium Salt Substitutes

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In this episode of the Global Heart Podcast, host Pablo Perel welcomes Prof. Mary L’Abbé and Prof. Jaime Miranda to unpack the 2025 WHO Guidelines on low-sodium salt substitutes. Prof. L’Abbé offers insights into the evidence, process, and recommendations behind the guideline, while Prof. Miranda discusses the broader implications for population health and sustainable development.

From hypertension and cardiovascular disease to global nutrition policy, this episode explores why salt substitution is being hailed as a potential game changer in public health.

Guests

Prof Mary L’Abbé Professor, University of Toronto Director, Collaborating Centre on Nutrition Policy for Chronic Disease Prevention

Prof. Jaime Miranda Professor & Head, School of Public Health, University of Sydney Senior Editorial Advisor, Global Heart Journal

Hosted by

Pablo Perel Senior Science Advisor at the World Heart Federation

Key Takeaways

Evidence Behind the Guidelines

- Blood Pressure Impact: Low-sodium salt substitutes reduce systolic BP by ~4.76 mmHg and diastolic BP by ~2.43 mmHg, with moderate-certainty evidence.

- Cardiovascular Outcomes: Substitution linked to a 30% reduction in coronary events and significant stroke risk reduction.

WHO Recommendation

- Conditional Recommendation: Endorsed for home use in adults only, with caution in those with kidney disease.

- Exclusions: Most studies excluded pregnant women, children, and people with kidney impairment—evidence not generalizable to those groups.

Implementation Challenges

- Equity & Access: Cost, healthcare infrastructure, and lack of kidney screening can hinder implementation in low-resource settings.

- Iodization Concerns: Salt iodization programs may need recalibration when replacing table salt.

Public Health Opportunity

- Prof. Miranda frames salt substitution as a population-level intervention, akin to statins and antiretrovirals.

- “Game Changer”: Calls for responsible rollout with built-in monitoring, citing its potential for broad societal and economic impact.

Beyond Health: Sustainable Development

- Links to SDG 3 (Health), SDG 8 (Workforce Productivity), SDG 13 (Climate), SDG 17 (Partnerships).

- Salt mining and production are not climate-neutral; alternatives may reduce environmental burden.

Research Gaps

- - - Lack of trials in children, pregnant women, transplant patients, and people with diagnosed CKD.
  - - Need for operational and supply-side research (e.g. logistics, economic incentives, delivery mechanisms).
  - - Questions about ideal sodium-potassium formulations remain open.